Chronic low back pain, Modic changes and low-grade virulent infection: efficacy of antibiotic treatment

Chronic low back pain (CLBP) has consistently been associated with the longest number of years lived with a disability in global studies, while commonly used treatments for CLBP are largely ineffective. In 2013 a randomized, double-blind, controlled study demonstrated significant improvements in CLBP patients demonstrating Modic changes type 1 on their MRI scans and undergoing long-term oral antibiotic treatment (100 days). Much of the ensuing debate has focused on whether this was a true infection or contamination. Newer and more advanced technologies clearly point to an ongoing low-grade infection. We have reviewed all of the clinical trials published in the recent past and conclude that there is compelling evidence for the effect of long-term oral antibiotic treatment for this patient group. Lay abstract: Long-term oral antibiotic therapy has been shown to be effective for a subgroup of patients experiencing chronic low back pain and with Modic changes seen on their MRI scans. Newer and more sophisticated analyses have demonstrated that these Modic changes are often due to an ongoing low-grade infection. We provide an update of treatment results from the published literature and conclude that the evidence for the effectiveness of this new therapy is compelling and that further studies should focus on identifying which patients are best suited to undergo this form of treatment.