Following on from Part 2 where we discussed P.acnes as a possible source of inflammation generating low back pain, we will now look at options with regards to detection and treatment.
Firstly, we must understand that there is no easily accessible test to determine whether Type 1 Modic changes on MRI are due to an insidious infection such as P.acnes. While direct biopsy of the affected disc has been done under controlled research conditions, this is not something that is available in the clinic. A blood test has been promoted as a possible tool for evaluating the presence of infection, although this is again not currently available for widespread use. The actual proportion of patients that have a true infection is therefore unknown and we cannot assume that all patients showing Modic changes are going to be affected. But it is worthwhile keeping the possibility of infection in the back of our mind when we are faced with a situation where treatment is not providing any resolution of symptoms.
A large number of studies have used high-dose antibiotics (Amoxicillin-Clavulanate) for 90 days to be successful in resolving the patients’ back pain. However, the possible long-term consequences of such an approach is not known. If within the 90 days, low back pain resolves, then at least we can target the inflammatory response due to the infection via the use of botanical herbs that have strong anti-bacterial properties and which support the down-regulation or inhibit the NF-kB pathway. Interestingly the NF-Kb pathway has been documented in many auto-inflammatory diseases as well as being prevalent in those infected with P.acnes.
It wasn’t until 2005, since the realisation that stomach ulcers were actually caused by infection (helicobacter pylori), and not simply the product of stress. This might be paralleled by an eventual realisation that chronic low back pain patients may be the victim of an ongoing low-grade infection.
So, if you have had a history of lumbar microdiscectomy which did not provide long term positive outcomes, low back pain for more than 6 months and the presence of Type 1 Modic changes on MRI, it would be wise to consider a 90 day trial of high-dose antibiotics (Amoxicillin-Clavulanate) following the MAST protocol. The concurrent use of botanical medicines that naturally inhibit the NF-kB pathway would also be beneficial.
The Chiro Hub is working in close conjunction with Dr. Vinesh Singh at Newave Medical in Alexandria. Dr Singh is a general practitioner with postgraduate qualifications in integrative and functional medicine. For further information on his services, click here.
I am more than happy to discuss how this 3 part blog series may relate to your current symptoms and/or condition. To promote better awareness of chronic low back pain, please share this blog series with a friend or loved one!