Publications (2)8.87 Total impact

  • Erik Dahl, Steven P Cohen
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    ABSTRACT: The inflammatory cytokine tumor necrosis factor-alpha has been shown to play a pivotal role in the development and maintenance of a wide variety of neuropathic pain conditions. Not surprisingly, systemic treatment with drugs that block tumor necrosis factor have been demonstrated to alleviate pain and pain-related behaviors in clinical and preclinical studies, respectively. Despite evidence that local administration of this drug class may be more efficacious than systemic administration, there are no clinical studies to support or refute this assertion. To report results on the use of perineural etanercept in 6 traumatic amputees with postamputation pain. The authors treated 6 soldiers with residual limb and phantom pain with a series of perineural etanercept injections. Five of the six patients reported significant improvements in residual limb pain at rest and with activity, phantom limb pain, functional capacity, and psychologic well-being 3 months after injections. The one soldier who failed therapy was the only patient who presented with pain greater than 1 year in duration. At the reduced doses administered, no adverse effects were observed. These findings support preclinical evidence that the local administration of tumor necrosis factor inhibitors may prove to be a safe and effective treatment for challenging pain conditions.
    Clinical Journal of Pain 03/2008; 24(2):172-5. DOI:10.1097/AJP.0b013e31815b32c8 · 2.70 Impact Factor
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    ABSTRACT: In recent years, convincing evidence has emerged implicating tumor necrosis factor alpha as a causative factor in radiculopathy and discogenic back pain. But although preliminary open-label studies demonstrated promising results for the treatment of low back pain with tumor necrosis factor-alpha inhibitors, early optimism has been tainted by a controlled study showing no significant benefit in sciatica. To determine whether outcomes might be improved by a more direct route of administration, the authors evaluated escalating doses of intradiscal etanercept in 36 patients with chronic lumbosacral radiculopathy or discogenic low back pain. A double-blind, placebo-controlled pilot study was conducted whereby six patients received 0.1, 0.25, 0.5, 0.75, 1.0, or 1.5 mg etanercept intradiscally in each pain-generating disc. In each escalating dose group of six patients, one received placebo. A neurologic examination and postprocedure leukocyte counts were performed in all patients at 1-month follow-up visits. In patients who experienced significant improvement in pain scores and function, follow-up visits were conducted 3 and 6 months after the procedure. At 1-month follow-up, no differences were found for pain scores or disability scores between or within groups for any dose range or subgroup of patients. Only eight patients remained in the study after 1 month and elected to forego further treatment. No complications were reported, and no differences were noted between preprocedure and postprocedure leukocyte counts. Although no serious side effects were observed in this small study, a single low dose of intradiscal etanercept does not seem to be an effective treatment for chronic radicular or discogenic low back pain.
    Anesthesiology 08/2007; 107(1):99-105. DOI:10.1097/01.anes.0000267518.20363.0d · 6.17 Impact Factor