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Perispinal Etanercept Effectively Reduces Acute, Chronic Pain Associated With Intervertebral Disc Disease

Patients with a history of treatment-resistant discogenic pain of lumbar or cervical origin reported significant, lasting improvement after perispinal administration of etanercept, according to researchers.

Edward L. Tobinick, M.D., and Susan Britschgi-Davoodifar, M.D., of the Institute for Neurological Research in Los Angeles, California, United States, collected data from records of 20 patients treated in their private clinic with etanercept, a tumour necrosis factor-alpha (TNF) inhibitor.

Symptoms of all 20 patients were believed secondary to intervertebral disc disease, based on magnetic resonance imaging (MRI) or computed tomography (CT) results, history, and physical examination. Patient age ranged from 38 to 79 years, and duration of pain ranged from 2 to 360 months.

Record selection criteria for the study included daily pain reported as severe (rated as 7 or greater on a scale of 1 to 10), chronic (lasting for at least 2 months and for 12 or more hours a day), treatment-resistant (lack of significant improvement with epidural steroid injection or spinal surgery), and significantly improved within 48 hours of treatment with etanercept.

Patients received one 25 mg dose of etanercept in 1 mL bacteriostaic water, injected subcutaneously into the perispinal region closest to disc protrusion. Researchers utilised the Oswestry Disability Index for pain level assessment prior to treatment with etanercept, 20 minutes after treatment, and at follow-up report (ranging from 49 to 518 days).

According to the researchers, Oswestry Disability Index scores dropped significantly for all patients quickly after treatment. Substantial pain reduction occurred within 24 hours of treatment for 19 patients, and within 48 hours for the remaining patient. Six patients required multiple (range of 0 to 5) doses to achieve response.

The researchers reported further benefits. "Additionally, all patients were able to reduce significantly or completely discontinue analgesic medication after etanercept treatment," the authors wrote. "Two patients who had been completely disabled were able to return to work full time."

While adverse reactions to etanercept treatment did not occur in these patients, researchers note toxicity as a potential hazard controlled by careful screening of the patient population.

Study limitations include a lack of formal control group and open-label treatment. The researchers conclude recommending further study.

Dr. Tobinick owns U.S. patents for various treatment methods discussed in the study. Also, both Dr. Tobinick and Dr. Britschgi-Davoodifar own stock in Abbott Laboratories and Amgen, which manufacture products noted in the study.
Swiss Medical Weekly 2003;133:170-177. "Perispinal TNF-alpha inhibition for discogenic pain"

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