Recent advancements in the treatment of lumbar radicular pain

Burnett, Chris; Day, Miles

doi:10.1097/aco.0b013e328303bfc9

Cited by 7 publications

(5 citation statements)

References 11 publications

(18 reference statements)

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“…Methotrexate was used in only 2 animal model studies . Of the five prior review articles, only one was a systematic review, which was focused primarily on the clinical efficacy of anti‐TNF drugs for LBP . As none of the reviewed trials employed any form of DMARD combination, the results are grouped further under the subheadings of the DMARD used.…”

Section: Resultsmentioning

confidence: 99%

“…Disagreements were resolved by mutual consensus. Of the 346 articles retrieved, 34 publications met the inclusion criteria and were further reviewed . The study analysis focused on the specific drug used, dose and mode of drug administration, efficacy of the drug, any safety measures adopted for the novel drug use, and the adverse effects reported.…”

Section: Methodsmentioning

confidence: 99%

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Disease‐modifying Antirheumatic Drugs for the Treatment of Low Back Pain: A Systematic Review of the Literature

2015

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Low back pain (LBP) is a common source of pain and disability, which has an enormous adverse impact on affected individuals and the community as a whole. The etiologies of LBP are protean and local inflammation contributes to the majority of these processes. Although an array of potent disease-modifying anti-rheumatic drugs (DMARDs), which are typically anti-inflammatory in character, have become clinically available only corticosteroids are routinely used for the treatment of LBP. To further investigate this potentially underutilized therapy, we reviewed the available literature to determine the role of DMARDs in the treatment of LBP. Our results show that the current DMARD use for LBP is indeed limited in scope and is characterized by isolated use and empiric selection of drugs from a range of available DMARDs. Moreover, the dose, frequency, and route of drug administration are selected arbitrarily and deviated from treatment protocols proposed for the management of other inflammatory conditions. The literature published on this topic is of low quality, and the results of the reviewed trials were inconclusive or demonstrated only short-term efficacy of these medications. Based on the findings of this review, we recommend that the future DMARD use for LBP is initially limited to patients with debilitating disease who are unresponsive to conventional treatments, and the criteria for drug selection and routes of drug administration are clearly defined and may be modeled after treatment protocols for other inflammatory conditions.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Disease‐modifying Antirheumatic Drugs for the Treatment of Low Back Pain: A Systematic Review of the Literature

2015

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“…Given the patient's severe low-back pain and its radicular component, we speculated that the symptoms were potentially the manifestation of nerve root irritation due to not only compression but also release of inflammatory cytokines in the perivascular space. 4,5,10,16 Thus, the patient was started on a short tapering course of dexamethasone, with the understanding that dexamethasone could theoretically exacerbate the symptoms because it can lead to increased intravascular volume. Furthermore, the patient was admitted to the neurosurgical intensive care unit for close monitoring.…”

Section: Case Reportmentioning

confidence: 99%

Cauda equina syndrome secondary to an absent inferior vena cava managed with surgical decompression

Ghiassi¹,

Ghiassi²,

Kahn³

et al. 2012

SPI

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The authors report on the case of a 24-year-old man who presented with back pain and radiculopathy due to epidural venous engorgement in the setting of a congenitally absent inferior vena cava. Despite initial improvement after steroid administration, the patient's health ultimately declined over a period of weeks, and signs and symptoms of cauda equina syndrome manifested. Lumbar decompression was performed and involved coagulation and resection of the compressive epidural veins. No complications occurred, and the patient made a full neurological recovery.

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“…Infliximab (and other selective anti‐TNF drugs, e.g., etanercept) has been used to treat lumbar radicular pain including severe sciatica [156–160] and rheumatoid arthritis [161]. Analysis of blister fluid from CRPS‐affected limbs of two patients indicated that local concentrations of TNF and IL‐6 were significantly decreased following selective anti‐TNF (infliximab) treatment.…”

Section: Is Tnf a Useful Target For Treating Crps?mentioning

confidence: 99%

Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome

Walker¹,

Drummond²

2011

Pain Med

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An exaggerated inflammatory cytokine cascade may contribute to sensory and autonomic disturbances in complex regional pain syndrome. Further investigation of anti-tumor necrosis factor-α therapy as a cost-effective treatment option for this devastating disease is required. Whether increased activity in the cholinergic anti-inflammatory pathway provides therapeutic benefits for complex regional pain syndrome also warrants further investigation.

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Recent advancements in the treatment of lumbar radicular pain

Cited by 7 publications

References 11 publications

Disease‐modifying Antirheumatic Drugs for the Treatment of Low Back Pain: A Systematic Review of the Literature

Disease‐modifying Antirheumatic Drugs for the Treatment of Low Back Pain: A Systematic Review of the Literature

Cauda equina syndrome secondary to an absent inferior vena cava managed with surgical decompression

Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome

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