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Do Acne Bacteria Cause Lower Back Pain?

acne infection and back painIn a recent study, Propionibacterium acnes, the organism that causes acne, was found in around half of herniated discs removed from patients with chronic low back pain. Is this pathogen an overlooked cause of lumbago, then? Or, is this merely coincidence?

The onset of rheumatoid arthritis was recently linked to a potential pathogen so could persistent pain in the lower back also be due to an underlying infection? P. acnes is a bacterium that can cause painful pustules on the skin, most often in teenage acne, but it has also been linked to ventriculoatrial shunt infection and even problems with prosthetic joints, shoulder joints in particular. Now it seems that this infection may contribute to ongoing back pain while remaining undetected.

Do You Have a P. acnes Infection?

P. acnes infection is atypical, as it doesn’t tend to cause a fever or increase sedimentation rates (the speed at which red blood cells settle in a test tube). Bacterial activity could explain how pain can seem to flare up at times and subside at others, however, and with one review finding that 97% of patients infected with P. acnes had previously undergone surgery, it could be that failed back surgery syndrome, persistent low back pain, and infection with the acne bacterium are linked.

Infection and Lower Back Pain

Sciatica, lumbar spine pain and herniated disc problems have actually been connected to infection with P. acnes since the early 2000s. A group of researchers in Denmark recently carried out experiments where disc material removed from patients undergoing discectomy was monitored in the laboratory resulting in 46% of these herniated discs testing positive for P. acnes.

These researchers also looked at MRI findings from the patients and in those whose discs tested positive for P. acnes, 80% had bone oedema adjacent to the damaged disc. This is known as Modic 1 and describes a condition where the degnerative disc has adversely affected nearby bone in the spine, leading to microfractures and a leaking of serum into the area, possibly contributing to back pain as this serum may promote inflammation.


Treating Back Pain with Antibiotics

In another trial, patients with Modic 1 findings on MRI were given either a placebo or amoxicilling/clavulanate for 100 days. The patients had all experienced back pain for at least six months and, of 162, 144 completed the study. After a year, those who had received the antibiotics had significantly less pain, as well as more improvement in Modic 1 changes, compared to placebo, even after the antitbiotic treatment was completed.

Steroid Dangers for Back Pain Sufferers

This raises interesting questions for those with chronic low back pain that seems resistant to corticosteroid injections and NSAIDs, even highlighting a possible increased risk from the use of immune-suppressing steroid medications for back pain. The increasing use of antibiotics is worrying, however, given the growing spread of antibiotic-resistant pathogens. Amoxicillin alone is sufficient to kill P. acnes infection in the laboratory, although with circulation to the spine minimal it may be that these bacteria have a particular fondness for this hard-to-reach area.

Reference

Uçkay I, Dinh A, Vauthey L, et al. Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature. Clin Microbiol Infect. 2010;16:353-358.
Stirling A, Worthington T, Rafiq M, Lambert PA, Elliott TS. Association between sciatica and Propionibacterium acnes. Lancet. 2001;357:2024-2025.
Agarwal V, Golish SR, Alamin TF. Bacteriologic culture of excised intervertebral disc from immunocompetent patients undergoing single level primary lumbar microdiscectomy. J Spinal Disord Tech. 2011;24:397-400.
Arndt J, Charles YP, Koebel C, Bogorin I, Steib JP. Bacteriology of degenerated lumbar intervertebral disks. J Spinal Disord Tech. 2012;25:E211-E216.
Albert HB, Lambert P, Rollason J, et al. Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? Eur Spine J. 2013;22:690-696.
Carricajo A, Nuti C, Aubert E, et al. Propionibacterium acnes contamination in lumbar disc surgery. J Hosp Infect. 2007;66:275-277.
Albert HB, Sorensen JS, Christensen BS, Manniche C. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013;22:697-707.

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