Modic Antibiotic Spinal Therapy – Treating Back Pain From Modic Changes With Antibiotics
Long thought to be a typical and “normal” finding on MRI studies, Modic Type 1 Changes, signify a rapid form of degenerative disc disease and are often associated with a bacterial infection of the disc, causing a form of spondylodiscitis. Modic antibiotic spinal therapy is providing relief for some when all else has failed.
This is a painful condition, often resistant to therapeutic measures with sufferers complaining of pain for many years, often disabling.
Current research has indicated that as many as 40% of chronic low back pain sufferers may have a bacterial infection of the disc which may be treated easily and at low cost with antibiotics in a protocol called Modic Antibiotic Spinal Therapy, developed by Dr. Hanne B. Albert, PT, MHP, PhD. and colleagues. Dr Albert is an Associate professor at the University of Southern Denmark, Denmark. She is not only brilliant, but a wonderful person.
Modic changes are 6 times more prevalent in sufferers of lower back pain than generally in populations. Again, Modic Changes had been considered as purely mechanical in nature, however, it is known that infections play a significant role. Typical treatments, like exercise, injections and manual adjustments or manipulation are not effective, and modic antibiotic spinal therapy is offering hope.
Modic changes can also be present in the neck, however, they are about 5 times more prevalent in the lower back. This corresponds to a higher prevalence of back pain than neck pain. The studies were done on low back pain patients, however, there is no indication that a similar process could not exist in those with chronic neck pain. The studies are performed on back patients and indicate a condition some term as “Modic Related Low Back Pain”, however, perhaps sometime in the future studies will additionally indicate a “Modic Related Neck Pain”.
It was discovered that a bacteria called Propionibacterium acnes, which thrives in an environment with no oxygen (anaerobic bacteria) was present in the discs of 43% of patients who underwent surgery for disc herniations in the low back. These Modic Type 1 Changes indicate a swelling of the bone and develop in the spinal bones (vertebrae) of 80% of the discs that are infected with the bacteria.
The bacteria are found in the mouth and in the base of hair follicles. Normally no threat exists from these bacteria. After brushing teeth, these bacteria are normally found in the bloodstream for about 10 minutes, where they pose no problem due to the oxygen in the bloodstream; remember – these bacteria do not like oxygen.
The picture above shows the structures involved in Modic changes. This is a normal representation of a healthy disc, with its soft inner nucleus and tougher outer annulus. Sitting atop the disc on either side are the end plates and atop those are the spinal bones.
How Does Bacteria Hurt The Spine?
When someone has a herniated disc causing lumbar spine pain, where the inside of the disc (nucleus) leaks out of its containment (annulus), the body responds by growing small blood vessels to carry white blood cells to “clean it up”. The material inside the disc is meant to stay there. It is a toxic material when outside the disc and causes an inflammatory response. The new blood vessels grow inside the soft disc in attempts to repair the damaged tissue.
The inflammation produces chemicals which cause the growth of raw nerve fibers into the area capable of transmitting pain. The new growth of blood vessels provides a way for the bacteria into disc. Because the disc normally has not blood vessels, when the bacteria get in, they have a perfect environment to set up residence. Although the bacteria do not reproduce rapidly, they do thrive, causing inflammation around the disc. Unfortunately, the bacteria secrete a chemical called propionic acid, which irritates nerves and can deteriorate the surrounding bone.
In the graphic to the left, you can see the damage in modic 1 changes. The picture on the right is an MRI, which is the only way to detect the Modic changes – they are not visible on standard x-rays. The green arrows show a relatively healthy, intact disc. The pink arrows point to a disc herniation, while the red arrows show a damaged disc that has lost the normal height, fluid inside has leaked out and the disc is infected. The blue arrows point to the modic changes which reflect a bone edema with fluid similar to a blister as the structure inside the bone is being destroyed by the acid secreted by the bacteria.
Many think the inside of a spinal bone is solid. However, there is a type of scaffolding structure which supports the bone and provides secure areas for red bone marrow. Through the effects of chemicals from the inflammatory process and the acid secreted by the bacteria, this invades the bone and destroys this structure. The acid secreted by the bacteria destroys calcium which the scaffolding is made of. This leads to small fractures called microfractures, swelling and the ingrowth of raw and pain sensitive nerve fibers. If it looks painful, I assure you, – it is! That sudden jolt of pain that takes your breath away and stops you in your tracks when bending forward or lifting may actually be a small fracture due to modic changes!
History Of Pain & Modic Changes:
Traditional low back pain that comes and goes. With treatment, goes away and maybe months or years without pain until a new episode. When you think about it, it is like the pattern of getting a cold or the flu. Represents a pattern of disc degeneration.
Long history of back pain and often a herniated disc. Now pain is always there and has varying intensity, but rarely goes away. This is because of the fractures and ingrowth of raw nerve fibers from Modic changes which do not go away. Morning is the worse pain, it eases up some during the morning and gets worse in the late afternoon and at night, which follows the pattern of inflammation.
Almost a third wake up at night from pain due to to turning in bed which is related to the inflammation, fractures and irritation of nerve fibers.
Pain is felt deep in the lower back and may radiate into the buttocks and into one or both legs. This can be related to the modic changes or may also be associated with a previous or current herniation.
Typical back exercises do not help. Working out, physical labor and sports activities typically cause an increase in pain. Again, related to fractures, inflammation and irritation of nerve fibers.
In fact a Feb. 2014 study published in the Spine Journal followed those with Modic Type 1 changes and noted an increased risk for no improvement in both pain and function as well as an inability of returning to work. This indicates a failure to respond to traditional therapeutic measures.
A 2020 study in the European Spine Journal of 814 subjects indicated low back pain was significantly higher in subjects with type I Modic change than in those with no changes. The authors concluded, “Type I Modic changes in the lumbar region are significantly associated with LBP [low back pain]. Profiling Modic changes may be helpful to improve targeted treatment of LBP.”
Since Modic I is significantly inflammatory, there is an inflammatory pain pattern (at least one of morning stiffness for longer than 60 min, waking at night, maximal pain when waking up).
Time Line In Modic Antibiotic Spinal Therapy
If antibiotics start at 100%, it will take approximately 6 to 8 weeks before anything happens. That’s almost 2 months! It is a slow, long cure that takes a year to complete. Not like a typical infection where you take antibiotics and are better in a matter of days or weeks. At 100 days, your only half way in the healing process! Does this mean everyone gets better? No. However, approximately 4 out of 5 do! It is possible the Modic changes are a result of degeneration and there is no infectious process.
Why does Modic antibiotic spinal therapy take so long? There are no blood vessels in the disc and this is where the bacteria live. The antibiotic must enter the disc and this happens by a process called diffusion. The best time for this process is at night when you are lying down and the pressure is taken off the disc and water enters the disc, like a sponge absorbing water, taking the antibiotic with it.
This is a slow process and happens a little at a time, however, the antibiotic must enter the disc and work it’s way into the infection where it can kill the bacteria, thus the production of destructive acid secreted by the bacteria will stop. The process is similar to healing a fractured bone. Once the bacteria are destroyed, healing of the Modic changes must take place; the fractures heal and the nerve fibers go away, and this process of Modic antibiotic spinal therapy takes a year to complete. The antibiotic used in the double blind study is Amoxicillin/Clavulanic acid (Augmentin or Bioclavid in Europe)
During the healing period – Anything that increases the pain is forbidden! Either immediately or the next day. You must learn how to pace yourself so that you can do activities, but not to the point where it causes pain. If you can walk a half mile with no pain during or after, however, walking a mile causes pain, then you should only walk a half mile. Activities should be light and variable.
Do I Have Modic Changes & What Can I Do?
A diagnosis of Modic Type 1 Changes requires a complete history, physical exam including an MRI scan. Only a treating doctor can make this diagnosis. If you currently have recent MRI Scans, they should be reviewed by your doctor or radiologist who is able to locate and identify any Modic changes.
As Modic Changes represents a complicated disease process, one that is relatively new and few have the knowledge regarding diagnosis, treatment and management, it is important to consult a doctor knowledgeable in Modic Antibiotic Spinal Therapy (MAST). Certified practitioners have undergone comprehensive training and successfully passed an examination. They are educated properly to diagnose as well as manage your condition successfully, increasing your chances of getting better and addressing issues during a year long therapy. Treatment is intensive and possible side effects must be addressed in an efficient manner. Certification is no longer offered.
There are some indications regarding the experience of those who suffer from Modic Type 1 Changes. The questionnaire below can give an indication of the possibility you may have Modic Type 1 Changes based on common experience. This gives a clue, however you should find a capable and knowledgeable doctor.
Basically, this questionnaire will give you a possibility of suffering from Modic Type 1 Changes. The more questions answered yes, the more likely are the possibilities. In general, answering yes to 3 or more questions, it is possible you are suffering from Modic changes and you should consider consulting a practitioner familiar or willing to become familiar with Modic Antibiotic Spinal Therapy.
I can tell you from experience, as having practiced as a health care provider for many years, having successfully taken the course and passed the examination, as well as being a sufferer of Modic 1 changes as confirmed by MRI, there is a desperate need for practitioners.
Modic Changes can be a very distressing and even disabling condition. Few are understanding as therapy after therapy, medication after medication, even surgery fail to produce results effecting a change in function. It may not be “all in your head” after all! Modic Antibiotic Spinal Therapy is giving hope to those who have given up and have no more hope. Dr. Albert has been a truly courageous pioneer. The impact on the lives who suffer from this, not to mention the potential savings to society in terms of treatment and disability costs could be tremendous.
Finding A Modic Antibiotic Spinal Therapy Doctor
With certification no longer offered, I have been working with patients and their doctors throughout the country to assist in implementing the procedure. I will be glad to help in this manner via correspondence. The patient information is here, therefore, you need a primary to agree, prescribe, and monitor. The basis for treatment is delineated in the double blind study.
Why Is It So Difficult To Find A Modic Antibiotic Spinal Therapy Doctor?
The hysteria over antibiotic resistance makes it difficult to to use antibiotics to treat “back pain”. Therefore, many doctors will shy away from this form of treatment. Although Modic changes are a specific condition, not contagious and are self limiting; you can wait about 20 years for it to progress from type 1, to 2 or 3 – a less painful form.
While it is practiced, especially in Europe, it is not so easy to find someone in the US. With confirmed Modic 1 objective and subjective findings, along with the right information, I find that many doctors care enough give serious consideration. I can council and provide some materials that can hasten the process.
I Can’t Take Antibiotics, What Can I Do?
Well, you can wait up to about 14 years for Modic I to convert to Modic II, which is less inflammatory and less painful, consisting of a fatty type of degeneration. It is a normal progression of the condition that will ultimately convert to Modic type III – sclerosis or hardening/calcification. Some doctors will consider biopharmaceuticals (biologics) or surgery.
A 2019 study in Pain Research & Management found a regimen that was more successful for Modic I than Modic II. Back exercises (mild extension in lying), pharmacological therapy, bed rest, change in lifestyle, and therapeutic massage.
The specific exercises can increase muscle strength and spinal stability. Non-Steroidal Anti inflammatory Drugs (NSAIDs) to help block various inflammatory markers to mediate inflammation as well as sensitized nerves. Muscle relaxants which can indirectly inhibit nerves acting on skeletal muscle. Bed rest as well as massages may reduce waist loading, which can relax back muscles and relieve pain.
The lifestyle changes consist of reducing load on the back. This is counterintuitive to most recommendations indicating increased activity for back pain, but if these measures have failed, the only choice is to avoid activities that are increasing pain. A change in diet may also be prudent.
If you are anywhere near Denmark, please contact Dr. Albert. She is absolutely wonderful, a friend as well as my teacher.
More information on Modic Antibiotic Spinal Therapy, I have written other articles: frequently asked questions about antibiotics for back pain, scientific support for Modic type changes as specific disease, progress on antibiotic spinal therapy, and chiropractic management of Modic changes.