Antibiotic Falls Short in Disc-Related Back Pain
A randomized trial found no greater pain reduction vs placebo, but questions remain about patients with type 1 Modic changes.
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By
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Kathryn Wighton
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May 28, 2026
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Objective:
To assess the efficacy of amoxicillin-clavulanate in reducing pain among patients with chronic low back pain and disc herniation compared to placebo.
Key Findings:
- At 12 months, mean pain reduction was 1.0 point for amoxicillin-clavulanate vs 1.1 points for placebo, with no significant difference.
- No differences in disability, work absence, or psychological measures were observed between groups at 12 months.
- Subgroup analyses did not show pain benefit among patients with Modic changes.
Interpretation:
The findings indicate that amoxicillin-clavulanate did not show a significant difference in pain relief compared to placebo.
Limitations:
- The trial was not primarily powered to test efficacy in patients with Modic changes.
- Generalizability may be limited as most patients were recruited from the community.
- Missing data for 18 patients and discontinuation of antimicrobial resistance sampling.
Conclusion:
The results indicate uncertainty regarding the efficacy of antibiotics for chronic low back pain with disc herniation.
