Perispinal TNF-alpha inhibition for discogenic pain

Swiss Med Wkly. 2003 Mar 22;133(11-12):170-7.

Abstract

Objective: To examine the potential of etanercept, a biological inhibitor of tumour necrosis factor-alpha (TNF), delivered by perispinal administration, for the treatment of pain associated with intervertebral disc disease.

Methods: Charts from 20 selected patients treated at our private clinic by perispinal delivery of etanercept 25 mg for severe, chronic, treatment-resistant discogenic pain were reviewed. Therapeutic benefit was assessed clinically and was documented by changes in a validated pain instrument, the Oswestry Disability Index. The patients were treated off-label with etanercept as part of our usual practice of medicine. Five detailed case reports are presented, including three additional patients.

Results: Rapid, substantial and sustained clinical pain reduction was documented in this selected group of patients. The cohort of 20 patients had a mean age of 56.5 and mean duration of pain of 116 months. Nine of the patients had undergone previous spinal surgery; 17 had received an epidural steroid injection or injections (mean 3.2). This group of patients received a mean of 1.8 doses (range 1-5, median 1.0) of etanercept during the observation period. The mean length of follow-up was 230 days. Clinical improvement was confirmed by a decrease in the calculated Oswestry Disability Index from a mean of 54.85 +/- 12.5 at baseline, improving to 17.2 +/- 15.3 (p <0.003) at 24 days and ending at 9.8 +/- 13 (p <0.003) at 230 days.

Conclusions: TNF inhibition by etanercept delivered by perispinal administration may offer clinical benefit for patients with chronic, treatment-resistant discogenic pain. Further study of this new treatment modality is warranted.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Back Pain / diagnosis
  • Back Pain / drug therapy*
  • Back Pain / etiology*
  • Chronic Disease
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / administration & dosage*
  • Immunoglobulin G / therapeutic use*
  • Injections, Spinal
  • Intervertebral Disc Displacement / complications*
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / drug therapy*
  • Male
  • Middle Aged
  • Neoplasm Proteins / administration & dosage*
  • Neoplasm Proteins / therapeutic use*
  • Pain Measurement
  • Receptors, Tumor Necrosis Factor / administration & dosage*
  • Receptors, Tumor Necrosis Factor / therapeutic use*
  • Receptors, Tumor Necrosis Factor, Type II
  • Retrospective Studies
  • Treatment Outcome
  • Tumor Necrosis Factor Decoy Receptors

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunoglobulin G
  • Neoplasm Proteins
  • Receptors, Tumor Necrosis Factor
  • Receptors, Tumor Necrosis Factor, Type II
  • Tumor Necrosis Factor Decoy Receptors
  • Etanercept