There has been quite a lot of press coverage recently about the use of antibiotics as a novel way to treat a certain type of back pain. This is based on recent research showing that in some instances a bacterial infection can be the cause of the problem.
Historically clinicians have looked for mechanical causes of pain such as disc pathology, joint strain and muscle dysfunction. A lot of studies have shown that no particular structural pathology can be linked to the presence of back pain, including disc and joint degeneration, which had tended to be blamed for most back pain in the past.
Most back pain is more related to what people do with their back and the stresses and strains people place on their back, whether it be from long periods of static sitting or from a dodgy lifting technique. The strongest evidence suggests that the biggest factors associated with back pain are lack of exercise, anxiety/ depression and having negative beliefs about the problem. So how you are feeling has a stronger correlation to back pain than any structural anomaly. This has revolutionised how we think about, and manage, back pain.
But this recent research has now shown that one structural problem does in fact have a very high correlation with back pain.
Disc degeneration is normally thought to be a pain free problem and is present in up to 91% of the pain free problem. However, in a minority of cases this can lead to other problems. Sometimes this can lead to bacteria that are naturally occurring but contained within the disc to leak into the surrounding bone. When they are kept inside the disc there is no problem but if they escape to the neighbouring bone then sometimes your body recognises them as a foreign body and this causes an immune reaction. This leads to inflammation in the bone and pain.
On an MRI scan this looks like dark patches on one view and light patches on another and is diagnostic of the problem. Tests would then need to be done to confirm the infection.
This problem can sort itself out over time but it normally takes months, and sometimes years. But now research has shown that this specific problem can be effectively treated with antibiotics like any other infection.
But it must be stressed that this is the case in a small minority of people with back pain and even a small minority of people with disc degeneration. If you have been told you have disc degeneration don’t assume you have this particular problem. Remember that disc degeneration is usually pain free.
Still, the biggest causes of back pain are related to what people are doing with their backs, their overall lifestyle and their negative beliefs about what the problem is and how best to manage it.
Physiotherapists are ideally placed to make a thorough assessment of back pain and advise on how best to manage it or to refer on for investigation when necessary.
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