Single Intradiscal Administration of the Tumor Necrosis Factor-Alpha Inhibitor, Etanercept, for Patients with Discogenic Low Back Pain

• Published in: Pain medicine (Malden, Mass.) Vol. 17; no. 1; pp. 40 - 45
• Main Authors: Sainoh, Takeshi, Orita, Sumihisa, Miyagi, Masayuki, Inoue, Gen, Kamoda, Hiroto, Ishikawa, Tetsuhiro, Yamauchi, Kazuyo, Suzuki, Miyako, Sakuma, Yoshihiro, Kubota, Go, Oikawa, Yasuhiro, Inage, Kazuhide, Sato, Jun, Nakata, Yukio, Nakamura, Junichi, Aoki, Yasuchika, Toyone, Tomoaki, Takahashi, Kazuhisa, Ohtori, Seiji
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2016
• Subjects: Adult; Aged; Aged, 80 and over; Analgesics; Back pain; Bupivacaine; Clinical trials; Etanercept; Etanercept - administration & dosage; Etanercept - therapeutic use; Female; Humans; Injection; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - drug therapy; Japan; Low back pain; Low Back Pain - drug therapy; Male; Middle Aged; Necrosis; Pain; Pain Measurement; Patients; Prospective Studies; Surgery; Therapeutic applications; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Young Adult; Tumor Necrosis Factor-Alpha; Intradiscal Administration; Inflammatory Cytokines; Discogenic Low Back Pain; Etanercept; Prospective Randomized Study
• ISSN: 1526-2375; 1526-4637; 1526-4637
• DOI: 10.1111/pme.12892

Abstract Objective. To examine the analgesic effect of intradiscal administration of a tumor necrosis factor-αα (TNF-α) inhibitor in patients with discogenic low back pain (LBP). Design. Prospective, randomized study. Setting. Department of Orthopaedic Surgery, Chiba (Japan) University Hospital. Subjects. Seventy-seven patients diagnosed with discogenic LBP. Methods. Discogenic LBP patients were randomly assigned to the etanercept (n = 38; bupivacaine [2 mL] with etanercept [10 mg]) or control (n = 39; bupivacaine [2 mL]) groups. Patients received a single intradiscal injection. Numerical rating scale (NRS) scores for LBP at baseline, 1 day, and 1, 2, 4, and 8 weeks after the injection were recorded. The Oswestry disability index (ODI) scores at baseline and at 4 and 8 weeks after injection were evaluated. Postinjection complications were recorded and evaluated. Results. In the etanercept group, the NRS scores were significantly lower than in the control group at every time point after the injection for 8 weeks (P < 0.05). Similarly, 4 weeks after the injection, the ODI score was lower in the etanercept group than in the control group (P < 0.05). However, the ODI scores were not significantly different at 8 weeks. Complications were not observed. Conclusions. Single intradiscal administration of a TNF-α inhibitor can alleviate intractable discogenic LBP for up to 8 weeks. TNF-α may be involved in discogenic pain pathogenesis. This procedure is a novel potential treatment; longer-term effectiveness trials are required in the future.