Treatment of chronic low back pain – new approaches on the horizon
Nebojsa Nick Knezevic,1–3 Shane Mandalia,1 Jennifer Raasch,1 Ivana Knezevic,1 Kenneth D Candido1–3 1Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 2Department of Anesthesiology, 3Department of Surgery, University of Illinois, Chicago, IL, USA Abstract: Ba...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2017-05-01
|
| Series: | Journal of Pain Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/treatment-of-chronic-low-back-pain-new-approaches-on-the-horizon-peer-reviewed-article-JPR |
| _version_ | 1818516161801748480 |
|---|---|
| author | Knezevic NN Mandalia S Raasch J Knezevic I Candido KD |
| author_facet | Knezevic NN Mandalia S Raasch J Knezevic I Candido KD |
| author_sort | Knezevic NN |
| collection | DOAJ |
| description | Nebojsa Nick Knezevic,1–3 Shane Mandalia,1 Jennifer Raasch,1 Ivana Knezevic,1 Kenneth D Candido1–3 1Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 2Department of Anesthesiology, 3Department of Surgery, University of Illinois, Chicago, IL, USA Abstract: 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. Keywords: chronic low back pain, clinical trials, chemonucleolysis, tanezumab, artemin, PRP, stem cells, new therapy |
| first_indexed | 2024-12-11T00:38:26Z |
| format | Article |
| id | doaj.art-2997d7dd6b4644e597c8edcd7abd16b5 |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-11T00:38:26Z |
| publishDate | 2017-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-2997d7dd6b4644e597c8edcd7abd16b52022-12-22T01:27:02ZengDove Medical PressJournal of Pain Research1178-70902017-05-01Volume 101111112332778Treatment of chronic low back pain – new approaches on the horizonKnezevic NNMandalia SRaasch JKnezevic ICandido KDNebojsa Nick Knezevic,1–3 Shane Mandalia,1 Jennifer Raasch,1 Ivana Knezevic,1 Kenneth D Candido1–3 1Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 2Department of Anesthesiology, 3Department of Surgery, University of Illinois, Chicago, IL, USA Abstract: 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. Keywords: chronic low back pain, clinical trials, chemonucleolysis, tanezumab, artemin, PRP, stem cells, new therapy https://www.dovepress.com/treatment-of-chronic-low-back-pain-new-approaches-on-the-horizon-peer-reviewed-article-JPRchronic low back painclinical trialschemonucleolysistanezumabarteminPRPstem cells |
| spellingShingle | Knezevic NN Mandalia S Raasch J Knezevic I Candido KD Treatment of chronic low back pain – new approaches on the horizon Journal of Pain Research chronic low back pain clinical trials chemonucleolysis tanezumab artemin PRP stem cells |
| title | Treatment of chronic low back pain – new approaches on the horizon |
| title_full | Treatment of chronic low back pain – new approaches on the horizon |
| title_fullStr | Treatment of chronic low back pain – new approaches on the horizon |
| title_full_unstemmed | Treatment of chronic low back pain – new approaches on the horizon |
| title_short | Treatment of chronic low back pain – new approaches on the horizon |
| title_sort | treatment of chronic low back pain ndash nbsp new approaches on the horizon |
| topic | chronic low back pain clinical trials chemonucleolysis tanezumab artemin PRP stem cells |
| url | https://www.dovepress.com/treatment-of-chronic-low-back-pain-new-approaches-on-the-horizon-peer-reviewed-article-JPR |
| work_keys_str_mv | AT knezevicnn treatmentofchroniclowbackpainndashnbspnewapproachesonthehorizon AT mandalias treatmentofchroniclowbackpainndashnbspnewapproachesonthehorizon AT raaschj treatmentofchroniclowbackpainndashnbspnewapproachesonthehorizon AT knezevici treatmentofchroniclowbackpainndashnbspnewapproachesonthehorizon AT candidokd treatmentofchroniclowbackpainndashnbspnewapproachesonthehorizon |