Identifying inflammatory targets for biologic therapies for spine pain.

The costs associated with treating spine-related conditions are enormous and are trending upward. Current methods employed to treat inflammatory-mediated pain are targeted at alleviating symptoms, rather than correcting the underlying cause of disease. It is clear that a biochemical basis for inflammatory-mediated intervertebral disk, facet joint, and nerve pain exists. Biologic therapies that address the underlying cause of pain could potentially decrease the costs associated with treating spine pathology. MMPs, IL-1, TNF- α, IL-6, NGF, bradykinin, prostaglandins, and nitric oxide are implicated in much of the catabolic effects seen in the pathogenesis of inflammatory-mediated pain and are good targets for inhibition. The anticatabolic and anabolic effects of TIMPs, BMPs, TGF- β, and IGF-1 are targets already shown to favorably impact disk matrix homeostasis. With rapid advances in biomedical technology, these interventions may be available for clinical use in the near future.