Is antibiotic treatment effective in the management of chronic low back pain? A clinical trial.

Low back pain is a major public health problem in Australia, ranking 2nd only to cancer as the leading cause of disability. While its prevalence is high, with 80% of Australians experiencing low back pain during their lifetime, effective treatments are limited. In 2013 a study was published which showed that antibiotics were effective in treating a specific type of low back pain involving injury to the disc and oedema of the bone. The trial was based on the hypothesis that following a disc injury (experienced as acute back pain) a secondary infection develops in the disc which leads to a chronic, disabling condition. There has been both immense interest and controversy regarding this trial. While leading, international surgeons suggest that it should be nominated for a Nobel prize, others have called for further research. To date the results of the trial have not been translated into clinical practice, as there are unanswered questions regarding the approach. The specific group of patients who need to be targeted is unclear, the effectiveness of this treatment in conjunction with standard care is unknown, and the costs and associated resistance to the antibiotic therapy has not been investigated. We aim to perform a clinical trial to investigate the effectiveness of antibiotic treatment in a broader group of individuals with chronic low back pain and a disc injury, to determine whether specific Magnetic Resonance Imaging (MRI) changes predict response to this approach, and to examine the cost-effectiveness and antibiotic resistance of this therapy. If antibiotics are found to be a cost-effective and safe treatment for some patients with chronic low back pain, this will provide a novel approach for the prevention of long term pain and disability in these individuals.