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We have had a love-hate relationship with bacteria since time immemorial. Before the development of antibiotics, what we would now consider to be trivial infections, were major killers, even of healthy adults.
And now the threat from bacteria is increasing again in two ways. One is that increasing numbers of bacteria have become resistant to current antibiotics and novel anti-bacterial compounds are not being developed quickly enough. The other is that bacteria are now being linked with diseases in which their role had previously not been recognised. These include back pain and heart disease.
What’s the link between bacteria and back pain?
Between the bones (vertebrae) in our back we have discs containing a jelly-like substance, which provide shock-absorption and provide flexibility in the spine. These discs can become pinched and squashed so that their jelly center breaks out or ruptures. In 35-40% of people this event causes swelling of the surrounding bone (known as Modic changes), leading to long-term low back pain. Back pain is a leading cause of pain and lost work time in the adult population.
Also 80% of those with the bacteria went on to develop new cases of Modic change. The bacteria are called Propionibacterium acnes, and belong to a class called anaerobes meaning they do not require oxygen to survive. They are the same ones responsible for teenage acne. It is thought they cause the bone swelling by producing propionic acid and stimulating the body’s anti-inflammatory mechanisms.
The discovery led to a trial in which back pain sufferers with the bacteria were treated with antibiotics or with placebo as a control, for 100 days. The antibiotic used is a very commonplace one called amoxicillin with clavulanic acid (Bioclavid or Augmentin) which is related to penicillin but includes clavulanic acid in order to overcome bacterial resistance.
Did the antibiotics resolve the back pain?
These changes increased from the end of treatment as long as the final follow-up in the study, which was one year after the treatment.