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More bacterial smoke than expected in low back pain (but still no fire)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Scientists found these little P. acnes buggers in most of the spines they checked. But were they already there causing a problem? Or were they contamination from the procedure?

Surprisingly, the door does not seem to have completely slammed shut on bacterial involvement in back pain, as one might have expected after the scandals over the early research. A new review of several more studies of the idea concludes that there is “moderate evidence for a relationship between the presence of bacteria and both low back pain.” Most studies have found bacteria in the spine, mostly Propionibacterium acnes. Could P. acnes be the Helicobacter pylori of the spine? The sneaky cause of a problem no one thought could be the work of a wee beastie?

I wouldn’t bet on it yet. “The mechanism by which bacteria may enter the lumbar spinal tissue is unclear,” wrote Urquhart et al, but it’s not unclear if it’s contamination! And there is already evidence that it is just contamination. And almost any evidence of contamination puts the whole business deep in the shadow of doubt. (This is probably why Dr. David Colquhoun tweeted at me, “‘moderate quality evidence’ — I doubt it”.)

Seems like the role of bacteria in back pain is still just a big question mark. It’s plausible and there’s smoke — much more plausible that I expected two years ago — but there could easily still be no fire here at all.

All together now: “more study needed”! As usual!

I’ve updated my low back pain book with this, because it’s the kind of odd back pain science I like to include just for kicks, even if it doesn’t amount to much.

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