Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Jay Metzger


Low virulence bacteria and back pain; Antibiotics back pain; Bacteria modic changes; Intervertebral disk herniation; Low virulence bacteria


Chronic back pain affects approximately eight percent of the American population, yet no treatment has been agreed upon universally. Recent studies suggest that between 20-30 percent of lower back pain cases are caused by a low-virulence bacterial infection of the intervertebral disks in those who suffered disc herniation. This scholarly project is to investigate: In patients with chronic lower back pain and Modic changes after disc herniation, what is the effect of antibiotic therapy on reducing pain symptoms compared to placebo. This literature review used the following electronic databases: ClinicalKey, Cochrane Library, Embase, and PubMed. Keywords and mesh terms refined searches to the most recent and relevant literature. The articles were then analyzed and refined, revealing 10 for critical review. The studies included are peer-reviewed and include a double-blind randomized control trial, pilot study, systemic literature reviews, literature reviews, monocentric study, and cohort study. A majority of the research presented shows evidence that Cutibacterium acnes, formerly known as Propionibacterium acnes presence in intervertebral discs, is not from contamination but rather is an infectious process that occurs after disc herniation. The research suggests that antibiotic treatment in those with chronic lower back pain and Modic changes after disc herniation is beneficial. Additional studies are required, but antibiotic therapy appears efficacious in reducing pain symptoms in those with chronic lower pain and Modic changes after disc herniation.