Low Back Pain Treatment Options for Primary Care

Future Options

A study from Denmark suggests that some patients with persistent low back pain may benefit from antibiotics. About 40% of patients with chronic back pain will have vertebral inflammation visible on an MRI. These changes are called Modic changes (MC) and are common in patients with disc degeneration. MC causes persistent, daily, localized back pain. When the damaged discs were biopsied as part of the study, almost 40% showed a type of bacteria called Propionibacterium acnes. 4,5

In a 2013 double-blind RCT study, published in the European Spine Journal, 162 patients with low back pain lasting longer than six months, herniated disc, and MC were randomly assigned to receive either 100 days of a broad-spectrum antibiotic or a placebo. Patients on the antibiotic had a significant improvement in their pain compared with patients taking the placebo. 4,5

“This study did get some attention in the U.S., but we have not seen any movement to start treating back pain with antibiotics. We will need to see some more well-designed studies that confirm this finding before we expose patients to 100 days of antibiotics,” said McGowan.

Anecdotal reports claim that when abdominal fat, which is rich in stem cells, is injected into a degenerating disc, it is possible to get nearly a 50% reduction in pain with very little risk. And if fat cells are autologous, unaltered, and injected on the day of harvest, the FDA does not consider it drug therapy and does not regulate the procedure. 6,7

That could be a routine office procedure someday, but we are not there yet. “The potential for abdominal stem cells to promote healing and regeneration of degenerated disc is potentially feasible, but the jury is still out on that one. The technology is still unregulated and unproven. Best bets for now are stop smoking, lose some weight, and start exercising for flexibility and core strength,” McGowan said.

Chris Iliades, MD, is a full-time freelance writer based in Cape Cod, Massachusetts.

This article was medically reviewed by: Pat F. Bass III, MD, MS, MPH.


1.     Low Back Pain Fact Sheet, National Institutes of Neurologic Disorders and Stroke.

2.     ACP Clinical Guidelines, American College of Physicians.

3.     Williams CM, Maher CH, Latimer J, et al. Lancet. 2014; 384(995):1586-96.

4.     Manniche C. Clin Pract. Special Report. 2014, 11(6), 585-590.

5.     Albert HB. Eur Spine J. 2013 Apr;22(4):697-707.

 6.     Surgeons are injecting the spine with fat from patient’s stomachs in ‘promising’ new treatment for chronic back pain, Daily Mail.

7.     Musculoskeletal Pain Relief With Stem Cell Infections, Medscape.