A radical new theory has emerged about what REALLY causes back pain for millions of sufferers – and it could be bizarrely linked to acne. Now this game-changing injection could end that misery for good

For millions of people back pain is a constant source of misery – but could an injection of an antibiotic gel in the spine finally banish it for good?

That’s the enticing prospect raised by the findings from a new study, due to be published tomorrow in the Lancet journal eClinicalMedicine, which suggests just a couple of jabs of the revolutionary gel could end suffering for patients with chronic back pain. The results, exclusive to Good Health, show pain scores in the 18 patients given the jab as part of a clinical trial more than halved, with the effects lasting up to a year.

Meanwhile, the number of patients needing to regularly take painkillers dropped from 80 per cent to 50 per cent, with use of powerful and potentially addictive opioid drugs more than halved in the gel group. Among the 19 volunteers given a placebo injection, there was no change in opioid use.

The experimental gel jab is based on the theory that many cases of back pain are due to a bacterial infection in the spinal discs – and that treating it with an antibiotic-loaded gel will cure the problem.

Back pain is one of the most common of all health complaints and, for nearly six million people, the pain is constant and long-lasting, affecting their quality of life and ability to work.

The most common cause is a slipped disc, where the spongy pieces of tissue that sit between and cushion the bones of the spine slip (or herniate) – often due to age-related wear and tear. This causes the disc to bulge, pressing on nerves and causing pain.

As well as painkillers, treatment usually involves physiotherapy to ease stiffness and prevent painful muscle spasms triggered by the herniated disc.

In severe cases, surgery may be necessary to fuse bones together in the spine to relieve pressure on the nerves causing the pain.

But over the last 15 years, a radical new theory for back pain has emerged – that many cases may be due to acne-causing bacteria that normally live on our skin.

Some studies have found that the bug in question – called Cutibacterium acnes – can also be found in damaged discs, where it produces a harmful acid that degrades surrounding bone and irritates nerves.

How it gets there is unclear, but some scientists think the bug, which also lives in the mouth, may get into the bloodstream due to poor dental hygiene – and then travel to the spine.

A 2013 study in Denmark concluded that up to 40 per cent of slipped discs were infected with the organism. It also found that prescribing 3g of the antibiotic amoxicillin daily (more than double that usually prescribed for infections) to those with back pain, for at least three months, significantly reduced pain and improved mobility.

However, two-thirds of those on the drug complained of side-effects, such as stomach upsets – and 12 per cent stopped taking the pills as a result. Prolonged use of high-dose antibiotics also increases the risk of bacteria becoming resistant to their effects.

At the time, the Danish discovery was heralded by some scientists as a major breakthrough in back pain research – potentially even worthy of the Nobel prize for medicine.

That hasn’t happened, but a UK firm, Kent-based Persica Pharmaceuticals, was set up to develop an injectable gel, called PP353, which contains the antibiotic linezolid – commonly used to treat skin infections and pneumonia, but used in the gel at a lower dose. Giving the gel by injection means all of the drug is delivered to the targeted damaged disc, reducing the risk of adverse effects that result from the drug travelling via the bloodstream and the gut. In theory, the lower dose means drug resistance is less likely.

Once injected, PP353 solidifies, which ensures it stays within the disc, stopping the bacteria.

In the latest study, funded by Persica Pharmaceuticals, volunteers from the UK, Spain, New Zealand and Denmark were given two jabs spaced a few days apart.

Some previously crippled by the pain were able to return to work or leisure activities such as swimming. Side-effects were comparable to those in the placebo group.

The company now hopes to collaborate with a bigger drug firm to set up larger trials and get the jab approved for use in the UK.

However, the idea that bacteria are responsible for back pain remains controversial.

A major study in The British Medical Journal in 2019 followed 180 patients with chronic back pain given 750mg of amoxicillin three times daily for three months – and found it was no more effective than a placebo.

Colin Natali, a consultant orthopaedic and spine surgeon at Princess Grace Hospital in London, says there is still a question mark over whether the presence of the acne-causing bug in the spine has anything to do with back pain.

‘The jury is still out – some people think the gel is wonderful, others that it’s a load of rubbish,’ he says.

‘It’s a great concept but there is a lot of controversy over the idea of treating back pain with antibiotics for long periods – even in gel form – because of the risk of drug resistance. Good treatments already exist – we know 90 per cent of people with chronic lower back pain get better with physiotherapy, and for those who don’t, steroid injections can be very effective.’

Anthony Ghosh, a neurosurgeon at Barking, Havering and Redbridge University Hospitals, said linezolid in the gel may work due to its anti-inflammatory properties – rather than any effect on bacteria in the disc.