Knezevic Nebojsa Nick, Mandalia Shane, Raasch Jennifer, Knezevic Ivana, Candido Kenneth D
Department of Anesthesiology, Advocate Illinois Masonic Medical Center.
Department of Anesthesiology.
J Pain Res. 2017 May 10;10:1111-1123. doi: 10.2147/JPR.S132769. eCollection 2017.
Back pain is the second leading cause of disability among American adults and is currently treated either with conservative therapy or interventional pain procedures. However, the question that remains is whether we, as physicians, have adequate therapeutic options to offer to the patients who suffer from chronic low back pain but fail both conservative therapy and interventional pain procedures before they consider surgical options such as discectomy, disc arthroplasty, or spinal fusion. The purpose of this article is to review the potential novel therapies that are on the horizon for the treatment of chronic low back pain. We discuss medications that are currently in use through different phases of clinical trials (I-III) for the treatment of low back pain. In this review, we discuss revisiting the concept of chemonucleolysis using chymopapain, as the first drug in an intradiscal injection to reduce herniated disc size, and newer intradiscal therapies, including collagenase, chondroitinase, matrix metalloproteinases, and ethanol gel. We also review an intravenous glial cell-derived neurotrophic growth factor called artemin, which may repair sensory nerves compressed by herniated discs. Another new drug in development for low back pain without radiculopathy is a subcutaneous monoclonal antibody acting as nerve growth factor called tanezumab. Finally, we discuss how platelet-rich plasma and stem cells are being studied for the treatment of low back pain. We believe that with these new therapeutic options, we can bridge the current gap between conservative/interventional procedures and surgeries in patients with chronic back pain.
背痛是美国成年人致残的第二大主要原因,目前主要通过保守治疗或介入性疼痛治疗手段来处理。然而,仍然存在的问题是,作为医生,对于那些患有慢性下背痛但在考虑诸如椎间盘切除术、椎间盘置换术或脊柱融合术等手术选择之前,保守治疗和介入性疼痛治疗均告失败的患者,我们是否有足够的治疗方案可供选择。本文的目的是回顾即将出现的用于治疗慢性下背痛的潜在新疗法。我们讨论了目前处于不同临床试验阶段(I - III期)用于治疗下背痛的药物。在这篇综述中,我们讨论重新审视使用木瓜凝乳蛋白酶进行化学髓核溶解术的概念,它是椎间盘内注射的第一种药物,用于减小椎间盘突出的大小,以及更新的椎间盘内治疗方法,包括胶原酶、软骨素酶、基质金属蛋白酶和乙醇凝胶。我们还回顾了一种名为artemin的静脉注射胶质细胞源性神经营养生长因子,它可能修复被突出椎间盘压迫的感觉神经。另一种正在研发用于治疗无神经根病的下背痛的新药是一种皮下单克隆抗体,名为tanezumab,它可作为神经生长因子发挥作用。最后,我们讨论了富血小板血浆和干细胞在治疗下背痛方面的研究情况。我们相信,有了这些新的治疗选择,我们能够弥合慢性背痛患者目前在保守/介入性治疗与手术之间的差距。