Question
I am a 50 yr. old WM, who has chronic lumbosacral radiculopathy from failed BAK cage assisted fusion surgery in 1998.High dose opioid/NSAID therapy is absolutely essential, but I feel that the anti-inflammatory meds are the most beneficial. I have seen some recently published case abstracts where TNF blocking agents like Humira/Remicade were successful in treating sciatica/lbp resulting from herniated lumbar discs. I have a consultation scheduled with Dr. Ziya Gokaslan on 3/28. If it is decided I am not a surgical candidate, would a short trial course of a TNF blocking (Humira/Remicade) class drug be available? Aside from TB and infections, what other risk issues should be considered? I want to thank you for generously dispensing your expertise in this forum.
Answer
The trials are with anti-TNF agents in acute sciatica not chronic back pain. TNF has been shown to be present in acute disc herniation and steroids (prednisone)is most effective in acute disease. Thus, ant-TNF agents seem to make the most sense in acute disease. I am not aware of any research to support the use of anti-TNF in more chronic disases.
