Current high-quality evidence does not support probiotics as an effective treatment for low back pain. Some probiotics, such as Lactobacillus rhamnosus GG, showed only minimal and clinically insignificant pain reduction in chronic low back pain with Modic changes. Probiotics have more established benefits in musculoskeletal health related to bone density and osteoarthritis pain, but not specifically for low back pain.
What the research shows
A high-quality randomized controlled trial (PMID 31309333) investigated Lactobacillus rhamnosus GG in patients with chronic low back pain and Modic type 1 or mixed changes. The study found no statistically significant differences in disability or pain outcomes between probiotic and placebo groups over one year, with only a small, clinically negligible reduction in back pain. Other studies focus on probiotics' effects on bone health, osteoarthritis pain, and musculoskeletal function, showing some benefits in bone mineral density and osteoarthritis-related pain and inflammation (PMIDs 39064686, 39553313, 33653743, 41457232). However, these findings do not directly translate to low back pain relief. Evidence for probiotics in functional abdominal pain and irritable bowel syndrome is more robust but unrelated to low back pain. Overall, probiotics are not proven effective for low back pain relief based on the supplied studies.
Best studied probiotic strains
Lactobacillus rhamnosus GG
Studied for: Chronic low back pain with Modic type 1 or mixed changes
Effect size was small and unlikely to be clinically meaningful; no safety concerns reported.
Lacticaseibacillus casei Shirota
Studied for: Rib fracture pain, knee osteoarthritis
Evidence supports pain relief in musculoskeletal conditions other than low back pain; further research needed.
Who may benefit
Safety
Probiotic treatments in the studies reviewed were generally safe and well tolerated, with no significant differences in adverse events compared to placebo.
Limitations
Evidence specific to probiotics for low back pain is limited to one high-quality RCT with minimal effect. Other studies focus on related musculoskeletal conditions or different populations. The small effect size and lack of clinically meaningful improvement limit recommendations. More targeted research is needed to clarify any potential role of probiotics in low back pain management.
PubMed sources
| Study | Type | Year | PMID |
|---|---|---|---|
| Probiotics for chronic low back pain with type 1 Modic changes: a randomized double-blind, placebo-controlled trial with 1-year follow-up using Lactobacillus Rhamnosis GG. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society |
Randomized Controlled Trial | 2019 | 31309333 |
| The Effect of Probiotics on the Management of Pain and Inflammation in Osteoarthritis: A Systematic Review and Meta-Analysis of Clinical Studies. Nutrients |
Meta-analysis | 2024 | 39064686 |
| Effects of probiotic supplementation on bone health in postmenopausal women: a systematic review and meta-analysis. Frontiers in endocrinology |
Meta-analysis | 2024 | 39553313 |
| Probiotic supplements and bone health in postmenopausal women: a meta-analysis of randomised controlled trials. BMJ open |
Meta-analysis | 2021 | 33653743 |
| Probiotic and synbiotic supplements for osteoporosis: a meta-analysis of randomized trials. Journal of health, population, and nutrition |
Meta-analysis | 2025 | 41457232 |
| Oral administration of probiotic Lactobacillus casei Shirota relieves pain after single rib fracture: a randomized double-blind, placebo-controlled clinical trial. Asia Pacific journal of clinical nutrition |
Randomized Controlled Trial | 2018 | 30485924 |
| The effect of probiotic Lactobacillus casei Shirota on knee osteoarthritis: a randomised double-blind, placebo-controlled clinical trial. Beneficial microbes |
Randomized Controlled Trial | 2017 | 28726510 |