Better Safer Pain Management?

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Dr. Edward Tobinick and Enbrel injection for discogenic pain

This is from another spine forum.

Dr. Edward Tobinick and Enbrel injection for discogenic pain

There is very suggestive, but as yet not fully confirmed evidence, that Enbrel injection can dramatically alleviate discogenic pain. The principal evidence comes from a randomized controlled trial done at Johns Hopkins and Walter Reed for sciatica. The trial was small but the results dramatic.

Of 24 patients in the trial, 6 received placebo and the other 18 received varying dosages of Enbrel injected via the disc epidural. Only 1 of the 6 receiving placebo showed improvement. Of the 18 receiving Enbrel injection, 13 reported more than 50% pain improvement lasting more than 6 months. Most of the 13 had virtually no pain at all after just two injections.

Enbrel is FDA approved for use in auto-immune conditions. In theory it works for discogenic pain by "down-regulating" "the inflammatory process (I'm not certain what this means).

Off label use of Enbrel injection for discogenic pain was pioneered by a Dr. Edward Tobinick in Los Angeles and is available from him currently. Dr. Tobinick charges some $4200 per injection, which you must pay up front.. But because Enbrel is FDA approved, and because California law mandates insurance coverage of off-label use of FDA approved drugs if such use is supported by two or more published medical journal articles, I got almost full insurance coverage from Anthem Blue Cross of California.

Dr. Tobinick tells me that Enbrel injection will not work if the disc is literally compressing a nerve or the spinal cord. It works if the discogenic pain is from inflammation alone: it is known that a herniated disc, even if it causes no compression, emits proinflammatory chemicals.

Dr. Tobinick does not inject Enbrel into the epidural space but into a venous system specific to the spine. This is a less invasive procedure than epidural injection. According to Dr. Tobinick, the spinal venous sysem was documented in medical journals as long as 70 years ago but forgotten till he rediiscovered it.

Dr. Tobinick acquired patent rights to his injection treatment. Those rights were acquired by a major pharmaceutical co. Cephalon for some tens of millions. Cephalon is testing treatment of sciatica with a new drug of the Enbrel family. Trials are in Phase 2 stage, are centered in Wellesley, MA.

I tried the Enbrel injection from Dr. Tobinick because the Hopkins trial convinced me it really works for some. But it did not work for me, probably because I have disc compression of nerve/spinal cord.

By the way, Dr. Tobinick confirms that cervical disc patients can present with head pain or low back and leg pain. Dr. Tobinick thinks pro-inflammatory chemicals travel via the spinal venous system and can thereby cause symptoms at locations remote from the herniated disc injury. His view offer support for the clinical observations of a Dr. Herman Kabat, author of Low Back and Leg Pain, whom I saw back in the 1970s, and about whom, more later. Kabat thought a significant percentage of patients with head pain or low back and leg pain suffered from herniated C6-7, but that the true source was never suspected by doctors applying the usual diagnostic criteria.