Could bacterial infection contribute to low back pain?

3rd February 2022 – By Aaruthy Suthahar

women sat in an office touching lower back due to back pain

Infection of the disc may be a factor in spinal disc degeneration and lower back pain, according to the latest TwinsUK research.  

Back pain, specifically low back pain, is now the world’s leading cause of disease. It is a huge problem globally and is associated with intervertebral disc degeneration, which is the breakdown of one or more of the cushioned discs that separate the bones of the spine. This causes pain in the back or neck and frequently in the legs and arms.  

In some cases, doctors see on scans bone marrow lesions known as ‘Modic change’, which may be associated with low back pain. The aim of this study was to identify whether there is an association between discs next to Modic change and bacterial reproduction. Previous studies have found the growth of bacteria following the removal of degenerated discs after spine surgery.  

The TwinsUK team carried out a review of existing research papers, looking at 36 research articles published between 2001 and 2021 reporting human studies which examined the role of bacteria in disc degeneration or Modic change in the bones which form the backbone. 

They found that a specific type of bacteria, Cutibactierum acnes, was commonly identified, although this may be because, in many of these studies, researchers have looked for and studied specific bacteria, which means they may have missed other bacteria that were present. 

Although several studies in this review reported that the presence of bacteria might be due to infection in the disc, other studies also suggested that contamination may have played a role during study procedures. Some research concluded that bacteria found in the disc may be due to contamination, meaning that the bacteria has come from the air or from the surgical team even though they were scrubbed up and wearing gloves.  

Further work is therefore needed to determine whether these bacteria are a result of contamination or represent a real infection of the spine, which contributes to chronic low back pain. This could be done by having a new method approach to look at all the bacteria present, rather than looking for specific bacteria. Researchers will also need to implement a suitable control to test how bacteria could be getting into the disc. 

First author, Isabelle Granville Smith, said: 

“It is exciting that we might have found contributing factors to disc degeneration as there is not much research on it. We now need to find a way to be able to extract as much information as possible of all the bacteria present rather than looking for specific bacteria.” 

Granville Smith et al. 2021. Evidence for infection in intervertebral disc degeneration: a systematic review. European Spine Journal.

Body or brain behind back pain?

22nd February 2019 – by Paz Garcia

Wooden mannequin with arm on back

Back pain may be caused through the body or through the brain, according to the results of a new genetics study.

The international team, which included researchers from King’s College London, studied the genetic information of over 500,000 people.

They found genetic links between back pain and some of its known risk factors, such as depression, sleep disturbance, obesity and smoking.

Overall, the results highlight the complexity of the genetics behind back pain.

Why did they do this research?

Back pain is very common, and many adults will experience it during their lives. About one in ten people however go on to develop chronic back pain, which can be debilitating and affect people’s quality of life and ability to work.

Previously the team had identified genes linked to chronic back pain. The researchers therefore decided to carry out a much larger study, to get a better understanding of how genes are linked to back pain.

What did the team do?

The researchers used data from two existing research programmes.

The team analysed the genetic data of 509, 070 people who indicated they were experiencing back pain, and examined the links between back pain and known medical and social risk factors.

What did they find?

The team identified two further genes linked with back pain.

The researchers also found genetic links between back pain and depression, sleep disturbance, obesity and smoking, which are known risk factors for back pain.

Based on their findings and further analysis, the researchers proposed two key routes through which back pain may start.

One route was through the vertebrae – disks – that make up the backbone. The other route was through how people perceive and process pain.

What does this mean?

These results support what we currently understand about back pain. The findings will also help researchers and healthcare professionals develop strategies to treat and prevent back pain.

Dr Maxim Freidin, who led the study, explained:

“This study continues our ongoing efforts to identify genes underlying back pain.

“One of the most striking finding is shared genetic component of back pain with many other traits such as obesity, depression and anxiety, social and demographic factors. These traits co-occur with back pain and are considered as its risk factors.

“By identifying shared genetics for back pain and these traits, we provide evidence that this co-occurrence has strong biological ground. In turn, this finding may help identify causal links between back pain and its risk factors.”

Watch the short animation below to find out more about our back pain research.

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