• Pain Med · Jan 2016

    Randomized Controlled Trial

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

    • Takeshi Sainoh, Sumihisa Orita, Masayuki Miyagi, Gen Inoue, Hiroto Kamoda, Tetsuhiro Ishikawa, Kazuyo Yamauchi, Miyako Suzuki, Yoshihiro Sakuma, Go Kubota, Yasuhiro Oikawa, Kazuhide Inage, Jun Sato, Yukio Nakata, Junichi Nakamura, Yasuchika Aoki, Tomoaki Toyone, Kazuhisa Takahashi, and Seiji Ohtori.
    • Pain Med. 2016 Jan 1; 17 (1): 40-5.

    ObjectiveTo examine the analgesic effect of intradiscal administration of a tumor necrosis factor-αα (TNF-α) inhibitor in patients with discogenic low back pain (LBP).DesignProspective, randomized study.SettingDepartment of Orthopaedic Surgery, Chiba (Japan) University Hospital.SubjectsSeventy-seven patients diagnosed with discogenic LBP.MethodsDiscogenic 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.ResultsIn 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.ConclusionsSingle 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.Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

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