Pathophysiology of disk-related low back pain and sciatica. II. Evidence supporting treatment with TNF-α antagonists - 01/01/05
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Abstract |
Strong evidence suggests that TNF- may be among the chemical factors involved in disk-related sciatica. TNF- is involved in the genesis of nerve pain in animal models and may promote pain-signal production from nerve roots previously subjected to mechanical deformation. In animal experiments, TNF- has been identified in nucleus pulposus and Schwann cells. Local production of endogenous TNF- may occur early in the pathogenic process. Exposure to exogenous TNF- induces electrophysiological, histological, and behavioral changes similar to those seen after exposure to nucleus pulposus, and these changes are more severe when mechanical compression is applied concomitantly. TNF- antagonists diminish or abolish abnormalities in animal models. Other cytokines may be involved also, as suggested by the potent inhibitory effects of compounds such as doxycycline. Two open-label studies in humans suggest dramatic efficacy of TNF- antagonists in alleviating disk-related sciatica. In contrast, the results of the only controlled study available to date do not support a therapeutic effect of TNF- antagonists. Thus, whether TNF- antagonist therapy is warranted in patients with disk-related sciatica remains an open question, and further randomized controlled studies are needed.
Le texte complet de cet article est disponible en PDF.Keywords : Disk-related sciatica, Tumor necrosis factor alpha, TNF- antagonists
Plan
Vol 73 - N° 3
P. 270-277 - mai 2006 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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