Acne bacteria to blame for back pain?

What do acne and chronic back pain have in common? Well, as it turns out, more than people once thought.  A group at the University of Southern Denmark have found that the same bacteria that gives people spots might be to blame for up to 40% of patients with lower back pain. What’s more, these infections can be treated with antibiotics.

 Acne bacteria to blame for back pain?

Slipped disc popping out from in between the evenly grey vertebrae

Your backbone is a column of alternating vertebrae (bones) and intervertebral discs (cushions). The bones provide the strength and support, while the cushion discs allow movement and flexibility. Occasionally, thanks to a mix of age and awkward movement, the disc can bulge out from between the bones. In some cases the jelly-like goo in the disc’s centre, called the nucleus, can even ooze out – a bit like thick jam leaking out of a doughnut. If the nuclear material or the disc itself puts pressure on nerves coming in and out of the spine, it can be even more painful.

 Acne bacteria to blame for back pain?Slipping a disc is, by all accounts, excruciating, but it usually starts to heal by 6-8 weeks. However, someone can be diagnosed with chronic back pain (CBP) when the pain doesn’t subside after three months. Trouble is, this happens all too often, with an estimated 4 million people in the UK suffering from CBP at some point in their lives. The cost of CBP to the NHS is about £1 billion per annum. This doesn’t even cover lost working hours or the loss of livelihood suffered. Treatment usually focuses on relieving pain, preventing inflammation and more recently, cognitive behavioural therapy to treat the patient’s psychology, especially if the organic, physical cause of the pain is no longer obvious.

Recently, scientists in Denmark found a really important link between the bacteria responsible for acne, known as Propionibacterium acnes (P. acnes) and bad backs. The researchers found that in about half of their patients with slipped discs, the disc itself was infected, usually with P. acnes. A year later, 80% of the infected patients – compared to 43% of the uninfected patients – had dodgier bones either side of the slipped disc than 12 months before. The affected bones had developed tiny fractures and the bone marrow was replaced with serum, the liquid found in blisters.

Akne jugend Acne bacteria to blame for back pain?

Acne is not to blame for bad teenage hairstyle choices.

So how did the discs get infected? Bacteria like P. acnes get into our bloodstream all the time, particularly when we brush our teeth or squeeze spots. P. acnes and other similar bacteria don’t like oxygen-rich environments and so don’t normally grow inside us. The spinal disc doesn’t have a lot of oxygen around, providing a perfect home for the bacteria. If the disc is damaged – say, after popping out from the spinal column – tiny blood vessels sprout into it, letting the bacteria move in and settle down.

There, the bacteria grow and, rather than spread anywhere else, they spit out inflammatory chemicals and acid. The acid corrodes the bone next to the disc and causes more swelling and pain around the area. This discovery is ground-breaking, since before this research it was thought that discs couldn’t get infected except in a few exceptional cases.

The Danish researchers then conducted a second study, testing whether simple antibiotics could get rid of these bacteria and therefore treat chronic lower back pain. Patients that already had the characteristic signs of bone inflammation (tiny fractures and swelling) were given a 100-day course of antibiotics. The patients were reassessed a year after the trial began. Patients treated with antibiotics reported less pain, less ‘bothersomeness’ (yes!), took fewer days off work, made fewer visits to the doctor and, crucially, their bones looked in much better nick than the patients given a placebo.

Considering the huge numbers of people who are affected by chronic back pain, and the cost of treatments like surgery versus a course of antibiotics, this discovery has been glorified as the stuff of Nobel prizes. The revelation that bacteria may be to blame for some cases of this mysteriously untreatable condition rings familiar. It has been likened to the discovery of the culprit bacteria behind stomach-ulcers, Helicobacter pylori. Like back pain today, stomach ulcers were dismissed for years to be a disease of the mind, endemic among stressed-out melodramatics or people who ate too much spicy food. (And yes, Barry Marshall did get a Nobel Prize for swallowing a Petri-dishful of H. pylori.) It would be fantastic if, instead of resorting to surgery, half a million CBP patients could be effectively cured within 100 days or less!

 Acne bacteria to blame for back pain?

The bacteria in the plate on the right have become resistant to many of the antibiotic white spots and so are more widespread.
Photo by Dr. Graham Beards

Unfortunately, there is a downside. Antibiotics have long been the magical cure-all, but just like fossil fuels, housing and talent on TV, we’re running out. Bacteria are becoming resistant to antibiotics faster than we can create new, effective ones. It’s an arms race and we’re losing, very quickly. What’s worse is that because of the recent negativity surrounding over-prescription, there are now restrictions on giving patients broad spectrum antibiotics. Since antibiotics can’t be used as much as they were 30 years ago, pharmaceutical companies can’t make any profit from developing new ones. And so, to further compound the problem of antibiotic resistance, there are fewer and fewer antibiotics being created every year.

In 2000 alone, UK doctors made 2.6 million prescriptions of antibiotics for acne. One study by a group in Leeds looked at the number of acne patients who were infected with P.acnes and were resistant to at least one type of anti-acne antibiotic. Between 1991 and 2000, the fraction of acne patients with antibiotic-resistant bacteria rose from about a third to more than a half.

The discovery that acne bacteria might be to blame for so many cases of debilitating back pain is hugely important. However, it also highlights how dependent we are on our dangerously dwindling supply of effective antibiotics, and how we might be wasting antibiotic effectiveness on comparatively trivial conditions such as spots.

Post by: Natasha Bray

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27 Responses to Acne bacteria to blame for back pain?

  1. dormand says:

    The current set of economics do not provide incentives for pharmaceutical companies to make the massive investments required to develop and get approved a new antibiotic for market, as there is only short time use of the drug.

    We need to develop a set of incentives for new antibiotics to be developed. Even more critical, we need to take steps to reduce the over use of antibiotics such as in animal feed that have resulted in antibiotic resistant bacteria.

    • thebrainbank says:

      Hi Dormand,
      Thanks for your comment – I couldn’t agree more! It is so short-sighted to overuse antibiotics despite the fact that all the way back in the 1940s Fleming pointed out that bacteria could become reistant.
      Cheers,
      Tasha

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  3. Was doing research into back pain as a lot of our customers suffer from it. I was ready with the comment about over-use of antibiotics as soon as I read that it had to be a 100 day course! But of course, it’s been addressed. Would the treatment work if the course was shorter and we reduce reliance on antibiotics for less serious conditions? Or is this a solution that has numbered days no matter which way we look at it?

    • thebrainbank says:

      Hi Liz,

      Thanks for your comment. The short answer is that I’m afraid I don’t know, but I hope you find the following information useful:

      The study where CBP patients, who had pain for >6 months following a slipped disc, were given a 100 day course of antibiotics is preliminary, but still important. I think it’s too early to tell exactly the impact that this research could have, although I think the crucial point for physicians to consider is that the disc might get infected more than people originally thought. In cases where patients with chronic lower back pain may resort to surgery, antibiotics may be a new option.

      The treatment that was used in this study was a mixture called Bioclavid, which is a mix of amoxicillin, a penicillin-like antibiotic that works by preventing bacterial cell walls from growing, and clavulanic acid, which blocks an enzyme that would otherwise break down the amoxicillin. These were first made and used back in the 1970s. Patients in the antibiotics trial were either given one or two of these pills a day – while the placebo groups were also given one or two dummy pills a day. In the journal article the researchers mention that while some patients felt their symptoms improve within weeks, other patients that did feel improvements only felt them towards the end of the course. Those given the two-pills-daily course didn’t have a significantly better outcome than those given one pill, but the authors of the paper comment that there may be a ‘trend’. These results indicate that work needs to be done on optimising the course of antibiotics.

      The authors note that antibiotics “should not be prescribed without due consideration” and remark that “antibiotics could be considered as a treatment option for this special subgroup of patients with CLBP and [bone damage] after a lumbar disc herniation when all other treatment options have failed“. They also write that further trials need to be conducted on patients from different populations and using better protocols (e.g. the course of antibiotics itself).

      I hope that helps answer your questions. Thanks again for reading!
      Best wishes,
      Tasha

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  5. Marjolein says:

    I find your article very interesting, however, I wanted to make a comment about spots being trivial. Serious chronic acne can have a very deep emotional and social impact on people. I have rosacea, not exactly acne, but similar. I also take antibiotics, this will never go away. Skin diseases can be very embarassing, and painful. , though they might seem trivial to people who don’t have them. I feel like my face is on fire most of the time, unless I take antibiotics.

    • Bev says:

      Hi,
      I too have Roseacea, have had it since I was 28, I am now 51. I read somewhere that not having milk would help. I gave up milk 6 months ago and my roceacea has never been better. It is ok to have cheese and yogurt but not milk or cream
      I was looking online for something to help my back acne now.
      People who have never had skin conditions do not realise how badly they affect your life.

      • Larisa Garpstas says:

        I am vegan and now gluten/wheat free. I had terrible adult acne show up and become relentless. After 6-9 months of many doctors, tests, and antibiotics, I took matters into my own hands and put together the pieces. I read many websites and books about the wheat-acne connection. I am now gluten free and acne FREE!!!!So I would also suggest going on a wheat/gluten free diet for about 1 full month to see if your symptoms are reduced or even vanish. Check ALL labels carefully!

  6. Carole says:

    I;ve been diagnosed with degenerative anterior listhesis of L3 on L4 and a grade 1-11
    degernerative anterior listhesis of L4 on L5. Marked desiccation of the L3 L4 and L5 and early desication of L2 L3. High grad soft tissue sagittal and bilateral lateral recess stenosi at L3L4 and L4L5, with patial epidural CSF block
    Bilateral foramimal narrowing at L3L4 an L4L5 ith possibility of asociated foraminal nerve rot iritationat these lvels. A shalow potero-cebtral prostrution of the L5S1 disc is present, ith shalow encrouchment at the leve L5S1 lateral reces.. Early narrowing ofthe left L5S1 exit forearm. Hip nd conu all ok.
    Could you help? Could my condition be related to what you are speaking about. Could it berelated and would going on yur antibiotic suggestions help men in any way?

    • thebrainbank says:

      Dear Carole,

      Thank you for your comment. I’m sorry to hear about your diagnosis. I am not a doctor so I’m afraid I can’t offer any medical advice relating to your case, but I suggest you ask your doctor.

      Best wishes,
      Tasha

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  8. Dr. J Malay says:

    There are many causes of lower back pain in men. This article is very enlightening and is something qualified doctors should consider when treating their patients.

  9. mandelic says:

    Very great post. I just stumbled upon your weblog and
    wished to say that I’ve truly loved browsing your weblog posts. After all I will be subscribing to your rss feed and I am hoping you write once more very soon!

  10. Karen DelGrosso says:

    This may be just a coincidence, but I have lower back pain & take Mobic, an inflammatory for it, well I developed an abscess on my gum about 2 months ago, my dentist prescribed 10 days of Amoxicillin, & I have realized just in the last 2-3 weeks that my back is so much better & I have not had to take a Mobic or anything , not even an aspirin. Just throwing this out there, may not be related at all but you never know.

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  12. Kimberly says:

    Great article, Natasha! I like it. I hope this discovery will help people to cure their back pain more successfully at the end. I suppose these antibiotics will help to damage acne bacterias but what about pain caused by slipping a disc itself? It’ll stay here. I think taking antibiotic course of 100 days also may bring various side effects to you in the long run too. Nevertheless it’s a genious discovery. Thanks for sharing it.

  13. BietryBrad says:

    Last year his team published a study about a phage treatment for acne. “Now
    with bacterial pathogens on an inevitable march toward …
    Lower back pain

  14. John Morgan says:

    I have been diagnosed with a lower back disc problem which has caused “referred pain” first to the hips s I lay on one side or the other at night, then to my bottom when I sit during the day. The treatment over 18 months to 2 years has been cortisone injections in the back with little or no improvement, and a pain killer at night to aid sleep.
    I had seen a report on this research but your article is the first to say “The affected bones had developed tiny fractures and the bone marrow was replaced with serum, the liquid found in blisters”.
    An unusual symptom that I have had was on several occasions I awoke with a blister on one or the other hip, once as large as an inch across, which disappeared with a few hours.
    Could this be related?

  15. John Morgan says:

    I should add that a specialist was very surprised that I do not have pain standing or walking. Indeed I can walk several miles and stand for long periods without any problem. Pain sitting or reclining can be within moments.

  16. Marilyn Doughty says:

    I have had two failed back surgeries (laminectomy and diskectomy) on L4-5 and L3-4, have stenosis, degenerating discs..I also had thermal ablation which didn’t do a thing to improve the pain. I have suffered terrible pain since 2001 and it seems to get worse every year. I talked about further surgery (decompression) but the risks are too high apparently. When I asked my Dr. to look into the antibiotic for backpain..she said if I had this bacteria it would show up in my white cells, and since my white count is normal, then it wouldn’t apply to me. Is that true? My life has been drastically impacted by this condition and I am getting desperate. This treatment sounds so much simpler than surgery. Is this being considered as a treatment in Canada or is it too soon to know.
    Mare

  17. Dr A says:

    As somebody who has worked with Propionibacterium acnes for many years, I think we do need to be a little cautious about the conclusions we draw with this study. As this bacterium is present in both the normal and diseased states, it can be frustrating to assign a definite role for this bacterium in various disease processes.
    It is very possible that in many cases what the researchers were culturing was P. acnes contamination from the skin of the back that contaminated the wound during surgery. While skin antiseptics used to prepare the skin prior to surgery are effective at eliminating skin surface bacteria, they are much less effective for bacteria in deeper layers.

    The effects of the antibiotics at reducing patient morbidity does suggest a bacterial role in the process, but it is unclear exactly the mode of action of these drugs. While antibiotics resolve acne symptoms, and therefore suggest a role for P. acnes in this skin condition, it is known that this effect may actually result from their anti-inflammatory properties and not due to any anti-bacterial mechanism.

    Even though it is a skin commensal, P. acnes has been linked to prostate cancer, sarcoidosis and other infections, so it is likely to be an underestimated opportunistic pathogen. The idea that the bacterium could be a cause of back pain is not, therefore, impossible. Hopefully, future studies will clarify the exact role P. acnes plays in this condition, one way or the other.

  18. Sarah says:

    Thanks for your post. I’ve lived with chronic low back pain for years after herniating my L4. Have tried everything from physical therapy to epidurals and heavy painkillers. Routine chiropractic care has given temporary relief, but problem continues. Is there a trial for this anywhere? I live in Philadelphia and would like to find anyone here with more information on this. Thank you!

    • thebrainbank says:

      Hi Sarah

      Sadly as research scientists we are not really able to advise on medical issues. However, it would certainly be worth speaking to your Doctor about this type of treatment.

      I do hope you can get something worked out!

      All the best

  19. Robert Neuman says:

    Found this very interesting. I was incapacitated with severe back pain in August 2008. After several emergency room visits a MRI was performed and I was diagnosed with Osteomyelitis at the L2/L3 level. Infectious Disease Doctors at Beth Israel hospital in Boston obtained a culture and determined that it was P Acnes. Never having any implants or back surgery they were perplexed on how I got this bacteria into my spine. After the insertion of a pick-line and three months of antibiotics I was rid of the bacteria. As Dr. A stated in his reply my doctors did think that at first the culture was caused by a contaminate from my skin and it wasn’t until a second culture was obtained and it too grew P. Acnes, that they determined this bacteria was the cause of my extreme pain.

  20. Kenneth Freedman says:

    I found this article searching for “degenerative disc disease” and “acne” together. This is because I suffer neck pain from DDD and get pain in my lower back, which is not chronic, and occasionally, am getting huge pimples in the same general area of my neck. I wondered if they were related. I was diagnosed with DDD over five years ago, and we decided surgery was not right for me, at the time, though I did get cortisone shots that virtually eliminated some of my symptoms and improved others.

    Can you tell me if finding these pimples may be an indicator of this condition and if there’s any chance that I may be able to get useful antibiotic treatment here in the U.S. based on that possibility?

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