Successful Abatacept treatment for an autoimmune disorder that causes painful and swollen joints

Source of Featured Image:

https://www.abc.net.au/news/2020-05-21/garvan-institute-genome-testing-helps-little-girl-find-treatment/12262238

Dear Pain Matters readers,

I am sure that you will enjoy this story about Karla as much as I did!

Genome testing has changed Karla De Lautour’s life and helped scientists understand her autoimmune condition (21/5/2020)

Quoting her rheumatologist, Dr Davinder Singh-Grewal,

“[Karla] had a lot of pain [due to painful and swollen joints], she was stiff every morning and it really was affecting her ability to live a normal life.” 

Enter Professor Chris Goodnow and his team at Sydney’s Garvan Institute who not only found a single fault in her genome, but also knew that an existing drug, Abatacept, could target the problem.

When Chris Goodnow met Karla for the first time (after successful Abatacept treatment), he was overjoyed to find Karla transformed into “a fantastic, chirpy, totally normal, 7-year-old”, thanks to his team’s research.

Not only does Abatacept directly target Karla’s painful autoimmune disorder, but it is also much easier for her to tolerate.

Karla now has an Abatacept infusion once every 2 weeks that offers her pain relief.

In closing, her rheumatologist said,

“Had they not sequenced the genome, [Karla] would have continued on in pain.”

Karla added,

“It feels better because it makes my pain go away and it feels comfortable.”

What could be better than this??

I hope you enjoyed this heart-warming story about Karla.

Sabina Walker

Blogger, Pain Matters (painmatters.wordpress.com)

MORE ON ABATACEPT

Abatacept (brand name Orencia) is part of a new class of medicines called biological disease modifying antirheumatic drugs (biological DMARDs or bDMARDs).

Abatacept blocks T cell (a type of white blood cell) responses. This leads to reduced inflammation, less joint damage and, best of all (from a patient’s perspective), decreased pain, swelling and other symptoms.

Abatacept is offered as a drip (infusion) into the vein. Alternatively, it is given as an injection under the skin of the abdomen or thigh (subcutaneous injection). The infusion usually takes 30 minutes. Additional doses may be given every 2 – 4 weeks after the first dose.

REFERENCES

(1) Lloyd, Mary. Genome testing has changed Karla De Lautour’s life and helped scientists understand her autoimmune condition. ABC News (21/5/2020).

https://www.abc.net.au/news/2020-05-21/garvan-institute-genome-testing-helps-little-girl-find-treatment/12262238

(2) Abatacept. Arthritis Australia

https://arthritisaustralia.com.au/medication-search/abatacept/

A SINGLE Perispinal Etanercept Injection by Edward Tobinick MD for Severe Nerve Pain including Sciatica and Post-Stroke Pain (2/2)

Feature Image sourced from:

https://seekingalpha.com/article/3956875-invivos-therapy-verge-becoming-de-facto-treatment-spinal-cord-injury

 

Dear Pain Matters blog readers,

Introduction

Infliximab, Etanercept and other selective anti-TNF drugs are sometimes used to treat:

• Lumbar radicular pain;
• Sciatica;
• Post-stroke pain;
• Complex regional pain syndrome (CRPS);
• Rheumatoid arthritis;
• Crohn’s disease; and
• Other painful conditions.

This blog post explores the pain-relieving effects of a single perispinal Etanercept injection in certain patients with sciatica, post-stroke pain and other severe nerve pain.

An earlier blog post discussed anti-TNF drugs (Infliximab) for CRPS:

Anti-TNF Drug (Infliximab) Therapy for CRPS and Other Chronic Pain Conditions (1/2)

A Single Perispinal Etanercept Injection for Pain in Back (Sciatica), Neck and after Stroke – 9 Patient Stories

A handful of pain patient stories (N=9) were selected from the Institute of Neurological Recovery’s (INR’s) website (that has over 300 patient videos).  This website also includes media stories, a blog and countless scientific publications by Dr Tobinick and his peers (see References).

https://www.nrimed.com

Please note the following disclaimer quoted from Dr Tobinick’s Patient YouTubes: 

‘Disclaimer: Individual results vary, not all patients respond. Additional doses may be necessary to maintain the clinical response. Treatment for these indications is innovative (“off-label”). The method of off-label treatment utilized is a patented invention of the INR®.’

 

(1) Kerry and Her Single Perispinal Etanercept Injection for Severe Leg and Back Pain ‘Kerry’ (not her real name) had intense right ankle, leg and back pain including burning pain for 6 months nonstop.  She walked very slowly with an abnormal gait to prevent the pain from shooting down her leg.  Her sleep was severely compromised. Kerry was offered a single dose of perispinal Etanercept by Dr Tobinick at the Institute of Neurological Recovery, Florida, on 11 September 2009. Kerry was immediately pain free at rest!  When her right leg was gently lifted, there was only a little pain. She said that this was likely due to not doing enough stretching exercises.   Kerry did not have pain in her buttocks nor lower back and her gait was vastly improved. In Kerry’s words, ‘I feel good!  Thank you.  Yeah, I feel good.’ At her follow-up 2 weeks later on 25/9/2009, Kerry said that she felt excellent.  She slept well and was able to do all her normal activities. Kerry attributed her complete recovery from pain and mobility to her single dose of Etanercept. For more details, please view Immediate and sustained relief from severe pain (a 4-minute YouTube dated 25/11/2009 by the Institute of Neurological Recovery, Florida). https://www.youtube.com/watch?v=Np62fRdIo1E

 

(2) Ana and Her Single Perispinal Etanercept Injection for Severe Back and Leg Pain ‘Ana’ (not her real name), a woman with a warm Spanish accent, suffered constant severe back and leg pain for 2 years. Ana’s unrelenting pain affected her mobility and sleep.  Her husband had to help put on her shoes and underwear.  Ana tried different pain medications including Tramadol, Vicodinand Naproxen without success.  Ultimately,Ana lost her job because of her ongoing pain. Ana booked an appointment with Dr Tobinick at the Institute of Neurological Recovery, Florida, on 4 May 2009. While seated during the examination, Ana’s left leg was gently raised.  This resulted in increased pain in her back that spread down her left leg. It was impossible to lift her other leg due to excruciating pain. Thereafter, Ana received a single dose of perispinal Etanercept.  Three minutes afterward, Dr Tobinick stated, ‘All right now. … The dose was at 9 minutes after 4, and this … is 3 minutes [later].  What is happening?’ Ana said, ‘I can move my legs!  [She laughs, with tears of joy in her eyes.]  Oh God! Oh God!’ Dr Tobinick asked, ‘Is this different?’ ‘Oh yeah!’, she exclaimed. He continued, ‘When was the last time you felt like this?’ Ana replied, ‘I don’t know, about 2 or 3 years ago.  Oh my God! … I can’t believe this!  Two years of pain … Oh my God!  Wow!  You’ve given my life back! Dr Tobinick asked, ‘What do you think?’ She tearfully said, ‘Thank you!’ Dr Tobinick continued, ‘How do your legs feel? … Before, it was hurting.’ She happily replied, ‘Oh, thank you … I have legs!’ He added, ‘Can you walk?’ She said, ‘Oh my God!’ Dr Tobinick said, ‘How do you feel?  Let’s go down the hall.’ Ana said, ‘Oh my God! … This is incredible!  Oh God.’ He asked, ‘Did it work?’ She enthusiastically replied, ‘Yes!! … Thank you so much!’ Ana (and her husband) had a follow-up visit with Dr Tobinick a week later on 11 May 2009. Ana’s husband exclaimed, ‘… This is another person.  That was not her … I got her back! … The smile! … She’s alive! … She’s getting back into the game … She’s moving!’ Ana had another follow-up visit with Dr Tobinick 3 months later on 14 August 2009. Dr Tobinick asked, ‘What kind of difference has this [single dose of perispinal Etanercept] made for your life?’ Ana replied, ‘Tremendous! … I’m holding my grandson and playing with him … I can have him in my lap and play with him. … And enjoy it!  I wasn’t able to do that before!  I’m doing a lot better!’ Dr Tobinick said, ‘Wonderful!’ ‘Thank you, Dr Tobinick!’ ‘You’re welcome!’ For more details, please view Immediate relief of 2 years of constant back pain and sciatica (an 8-minute YouTube dated 25/11/2009 by the Institute of Neurological Recovery, Florida). https://www.youtube.com/watch?v=vP6Nw1_OGIg

 

(3) Brenda’s Single Perispinal Etanercept Injection Brings Fast Relief from Severe Sciatica A young woman named ‘Brenda’ (not her real name) had a slipped disc in her 4th vertebra and severe sciatic pain for 5 months since December 2008.  Her gait was affected and she had severe pain from the right side of her lower back and buttocks that spread down both legs.  There was unbearable pain in her right leg down to her toes and less pain in her left leg. Brenda was given Vicodin, steroids and morphine injections for her pain, to no avail.  When she was rushed to hospital for severe back pain (several times), the neurosurgeon told her that she needed emergency back surgery. When Brenda went to see Dr Tobinick on 21 April 2009, he confirmed that the pain on the right side of Brenda’s back worsened when her left leg was lifted.  Thereafter, Brenda was offered a single dose of perispinal Etanercept. Within only 1 minute after her injection, Brenda’s knee no longer hurt!  There was no pain in her back even as she lifted both legs.  When she stood up to walk around, there was nil pain and her gait was normal. Happy to finally be pain free, she started dancing! When asked by Dr Tobinick, ‘How much pain do you have?’ She replied, ‘I don’t have any pain!’ He confirmed, ‘Your pain is all gone?’ She answered cheerfully, ‘I’m not in pain!  Nope, I’m not in pain!  Nope! I’m good!  Before, I couldn’t stand on this leg … I feel good!  I feel great!’ For more details, please view Rapid relief after 5 months of severe sciatic pain (a 5-minute YouTube dated 7 Jan 2016 by the Institute of Neurological Recovery, Florida). https://youtu.be/2K5yLrJSq0A https://www.nrimed.com/videos-by-category/back-neck-pain/

 

(4) Tim’s Single Perispinal Etanercept Injection Offers Relief from Sciatica in Minutes ‘Tim’ (not his real name) went to see Dr Tobinick on 4 April 2007 for severe sciatica.  The intense pain was constant and unbearable for 3 weeks and affected his work, quality of life and sleep.  He had pain in his back and buttocks that extended down his left leg to his calf. In Tim’s words, ‘It feels like somebody took a baseball bat and hit my leg.’ The pain increased in Tim’s left (not right) leg when Dr Tobinickgently moved his right leg.  Tim’s pain was more intense when seated and it lessened when he stood up.  He was able to walk ‘with a slight limp but real slow … real gently’. Tim had pain relief within a 1 minute after Dr Tobinickinjected Etanercept perispinally.   In response to Dr Tobinick’s question about how he was feeling right after the injection, Tim replied, ‘[The pain] feels kind of pulsating right now … down my leg.  It’s not a constant pain like it was.’ Dr Tobinick replied, ‘… So [the pain has] changed in character a little bit … already’ ‘Correct,’ Tim replied.  ‘I feel it in my butt still but not down the leg.’ Dr Tobinick confirmed, ‘But you feel it in your lower back and in your butt?’  ‘Correct.’ Dr Tobinick continued, ‘But you’re starting to feel a little bit more comfortable … in general?’ ‘Yeah…yes!’  ‘… And your leg?’ ‘It’s a miracle.  It’s amazing.’ ‘You’re walking a lot faster … Wow!’ Tim replied, ‘Yeah I’m loving this stuff.  Once again, it worked!’ Dr Tobinick phoned Tim 3 months later on 3 July 2007 to follow up. ‘I’m wondering now how you’re feeling?’ Tim replied, ‘I am feeling like a million bucks, doctor!’ Pleased for his patient, Dr Tobinick said, ‘I love it!’ Tim continued, ‘… By the time I got back to UCLA that day [of the perispinal Etanercept injection], I was better … You would have never known I had a back problem! …’ Dr Tobinick said, ‘That’s fantastic! … You know, you had some very interesting findings. That finding of moving your right leg, making your left leg hurt, that’s a very specific finding that indicates inflammation of the nerve root.  And so, it was clear what we were treating.  And that, of course, got better, very quickly … So, it’s very interesting, scientifically … You’re better, and you didn’t have to have surgery!’ Tim replied, ‘Yes, I am too. That’s wonderful stuff you got there.’ For more details, please view Improvement within minutes in sciatica (an 8-min YouTube dated 12 Nov 2009 by the Institute of Neurological Recovery, Florida). https://www.youtube.com/watch?v=xyfSgMoNsKY#action=share https://www.nrimed.com/videos-by-category/back-neck-pain/

 

(5) Gerry’s Single Perispinal Etanercept Injection Offers Pain Relief in Minutes after 5 Years of Sciatica ‘Gerry’ (not his real name) suffered from sciatic pain for 5 years nonstop.  In his words, he had pain ‘every day, all day’.  Gerry tried different treatments including chiropractic and decompression treatments. Dr Tobinick treated Gerry for sciatica via a single dose of perispinal Etanercept.  It took ‘just a few minutes’ for the Etanercept to offer lasting pain relief (as confirmed at the follow-up 2 weeks later on 9 July 2009). For more details, please view Relief in minutes after 5 years of constant pain (a 1-min YouTube dated 6 January 2016 by the Institute of Neurological Recovery, Florida). https://youtu.be/d0WRKmrE9Bw https://www.nrimed.com/videos-by-category/back-neck-pain/

 

(6) Mirabelle has Improved Hand Strength After A Single Dose of Perispinal Etanercept ‘Mirabelle’ (not her real name) suffered ongoing and never-ending severe pain for 15 years.  Walking and standing up caused pain in her hips and low back.  Mirabelle had pain in both hands.  Her left hand was weaker and more painful than her right hand ever since her ski accident in 1986 or 1988. Mirabelle was seen by nearly 30 different doctors including 10 or 11 pain specialists. During her appointment with Dr Tobinick, Mirabelle received asingle dose of perispinal Etanercept. When followed up 2 weeks later on 24 October 2007, Mirabelle had significantly more strength in both hands, compared to before Etanercept injection.  Her hands no longer had ‘that arthritic feeling’ (that she felt for weeks). While there was some residual muscular pain, Mirabelle no longer had neck pain, post-Etanercept. For more details, please view Hand improvement after treatment at the INR in 2007 (a 6-min YouTube dated 6 January 2016 by the Institute of Neurological Recovery, Florida). https://youtu.be/6-rXP4ZEDXk https://www.nrimed.com/videos-by-category/back-neck-pain/

 

(7) Caroline’s Sole Perispinal Etanercept Injection Relieves 25-Year Pain in 10 Minutes At follow-up on 15 July 2009, 2 weeks after ‘Caroline’s’ (not her real name) single injection of perispinal Etanercept, Dr Tobinick asked, ‘What happened [after this injection]?’ Caroline replied, ‘… I got up … I felt … so much taller … I felt … this wonderful feeling … I stood up and it was just great … I was elated because Ihave been in pain for sooo long … [The pain was] like a knife going through you …’ Dr Tobinick continued, ‘And how long did you have the pain?’ Caroline answered, ‘Oh, I’ve had the pain … I started maybe 25 years ago …’ He asked, ‘How long?’ Caroline clarified, ‘This has been the worst, these last few years. … The last 4 years.’ Dr Tobinick asked, ‘Have you had it every day?’ She replied, ‘Just about!’ He continued, ‘Just about every day? And how many hours a day were you having the pain before you came in?’ Caroline answered, ‘Oh gosh, very, very often.’ He clarified, ‘So most of the day? …’ Caroline stated, ‘And this time when I had that injection, it’s unbelievable.’ ‘How long did it take to work?’ he asked. ‘10 minutes!’ ‘10 minutes,’ he confirmed. She said, ‘Unbelievable.  It is.  It really is! Dr Tobinick asked, ‘Has anything like this happened at all in the last few years?’    ‘No.  [Not] at all,’ she replied.  ‘It’s incredible.  I really did not believe this could happen …’ Dr Tobinick asked, ‘Have you had to take any pain medicine in the last 2 weeks?’ ‘No,’ she answered. ‘Not a single … no pills?  Nothing?’ he confirmed. ‘Nothing! ‘Ok,’ he said. ‘It’s really great! …’, she said.  ‘…I’ve had … surgery … I got worse.’ Dr Tobinick asked, ‘You had surgery for your back?’ ‘Yes!’ ‘And you got worse?’ ‘And I got worse … And yet I come to this, and it’s great! … It’s the greatest thing that’s come along. …’ ‘… Alright, thank you very much,’ Dr Tobinick said. For more details, please view the 4-minute video called Rapid pain relief after 25 years of pain July 15, 2009 (a 4-min YouTube dated 6 January 2016 by the Institute of Neurological Recovery, Florida). https://www.youtube.com/watch?v=3ClVijm0MAA&feature=youtu.be&app=desktop

 

(8) Lola and Her Single Perispinal Etanercept Injection for Post-Stroke Pain ‘Lola’ (not her real name) suffered ongoing severe pain for almost 2 years after a stroke on 27 November 2016.  Her excruciating pain (10/10) affected the entire left side of her body including arm, breast, ribs, hip and leg.  She rarely moved her left arm nor left foot due to extreme pain.  Walking was next to impossible as her pain would only intensify with activity. Lola tried Baclofen and Gabapentin for pain without success. Lola booked an appointment with Dr Edward Tobinick on 20 November 2018, almost 2 years after her stroke.  After an assessment, Lola received a single perispinal Etanercept injection. Lola enjoyed immediate pain reliefand improved left arm mobility within 10 minutes after her injection.  Her pain levels in her chest dropped to 6/10.  Lola was finally able to move her left arm without pain.  The spasticity in her left arm was also reduced. Lola no longer had hip pain (that was 10/10 prior to injection).  The pain in her left leg and foot was gone, she was able to move her left foot for first time in 2 years and her balance was significantly improved.  Lola finally took her first steps without pain. Overall, Lola enjoyed significantly less pain and enhanced mobility thanks to her single Etanercept injection. According to her daughter, there was a new look in Lola’s eyes. When Dr Tobinick asked, ‘Are you happy you’ve come?’, Lola replied, ‘I’m very happy … And I hope I give hope to other patients too!’ For further details, please view Immediate improvement in chronic post-stroke pain nearly 2 years after stroke (a 3-minute YouTube dated 28/11/2018 by the Institute of Neurological Recovery, Florida). https://www.youtube.com/watch?v=FLZhVil56qM

 

(9) Debbie and Her Single Perispinal Etanercept Injection for Post-Stroke Pain ‘Debbie’ (not her real name) had a massive stroke that led to mobility issues and severe, unrelenting pain in her neck, both shoulders and upper left arm.  While strong pain medication reduced some of her pain, it did not eliminate it. Debbie was unable to get out of a chair without assistance and she required a wheelchair during shopping.  She had significant loss of function in her left hand and arm as well as loss of sensation in the left side of her body including face, hand and leg. Debbie had her first appointment with Dr Tobinick 3 years after her stroke on 29 February 2012. Dr Tobinick asked, ‘Do you have pain every day?’ ‘Yes, every minute of every day, I’ve got pain.’ Dr Tobinick confirmed, ‘Every minute of every day?  You have constant pain?’ ‘Yes’, she replied. ‘Even now, you’re in pain?’, he asked. ‘Yes, I am…’ Within only minutes after a single perispinal Etanercept injection, Debbie had significantly less pain and restored sensation to the left side of her body including face, hand and leg. The motor skills in her left hand were dramatically enhanced and she was finally able to get out of a chair without assistance. ‘How different is that from before?’ ‘I can’t believe it.  It’s a miracle!’, she said with a big smile.  It’ll change my life totally!’ For further details, please view Rapid improvement in chronic post-stroke pain 3 years after stroke (a 4-minute YouTube by the Institute of Neurological Recovery, Florida). https://www.youtube.com/watch?v=ic-6tk7MF5Y

 

Perispinal Etanercept Injections for Pain due to Bone Metastasis – Case Study (N=2) Two patients received perispinal Etanercept injections near the site of bone metastases for pain.  This treatment led to (quoting) ‘rapid, substantial, and sustained relief of chronic refractory pain at the treatment site’ in both patients (Tobinick, 2003).

 

Perispinal Etanercept Injections for Chronic Back and/or Neck Disc-Related Pain – A Study (N=143) A study was done involving perispinal Etanercept injections into the spine of 143 patients with chronic back and/or neck disc-related pain.  This treatment led to significant reductions in pain, sensory dysfunction and weakness (Tobinick and Davoodifar, 2004).

 

An Australian Trial involving Perispinal Etanercept Injections for Stroke Inspired by the outstanding results achieved after a single perispinal Etanercept injection by Dr Tobinick at the Institute of Neurological Recovery (INR), Florida, a clinical trial is now underway for stroke patients in Australia. Quoting, ‘The project will enable more Australians of working age who have had a stroke to access new … treatment options to aid their recovery.’   While results are not yet finalised, further details are here:   $1 million to support the rehabilitation of stroke survivors (6 October 2018) https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/1-million-to-support-the-rehabilitation-of-stroke-survivors             http://www.nrimed.com/wp-content/uploads/GH134.pdf   Australian Government designates funds to advance Perispinal Etanercept stroke research in Australia (8 October 2018) http://www.strokebreakthrough.com/blog-posts/uncategorized/australian-government-designates-funds-to-advance-perispinal-etanercept-stroke-research-in-australia/

Summary

More research into anti-TNF drug treatment for CRPS, sciatica, post-stroke pain and other nerve pain conditions is encouraged.  Such studies should confirm whether localised TNF levels are elevated in CRPS-affected limbs and other pain-affected areas in the first place.  If yes, analysis is necessary whether any anti-TNF drug treatment leads to a significant reduction in these elevated localised TNF levels, and if yes, whether this is also accompanied by reduced pain (etc).  Induced skin blisters or skin biopsies may be necessary to confirm localised TNF levels in CRPS-affected limbs and other pain-affected regions, both ‘before’ and ‘after’ anti-TNF drug treatment.

NOTE:  If localised TNF levels are already low to begin with (prior to anti-TNF drug treatment), anti-TNF drug treatment is (likely) not indicated.

Possible adverse effects also need to be considered prior to anti-TNF drug treatment.  Medical supervision is always advised.

 

Wishing all pain patients less pain,

Sabina Walker

Masters Appl. Science (Neuroscience)

Blogger, Pain Matters (in WordPress)

painmatters.wordpress.com

and

Author of soon-to-be published book called Pain Matters 

Twitter

@SabinaWalker18

 

For more information about Dr Tobinick’s treatment involving perispinal Etanercept for nerve pain, please see:

https://www.nrimed.com

Patient videos (N=307) by the Institute of Neurological Recovery, Florida:

https://www.nrimed.com/videos-by-category/

https://www.nrimed.com/videos-by-category/back-neck-pain/

https://www.nrimed.com/videos-by-category/stroke-pain-videos/

Scientific publications by Dr Tobinick and his peers:

https://www.nrimed.com/inr-scientific-publications/

Media stories:

http://www.nrimed.com/about/media-stories/

Blog by the Institute of Neurological Recovery, Florida:

https://www.nrimed.com/blog/

Please note that treatment involving perispinal Etanercept injection is protected by multiple patents owned by Edward Tobinick MD including U.S. patents 6 015 557; 6 177 077; 6 419 944; 6 537 549 and Australian patent 758 523 (Tobinick and Davoodifar, 2004).

 

PS YOU DON’T HAVE TO READ THE FOLLOWING UNLESS YOU ARE INTERESTED IN THE UNDERLYING SCIENCE 

POSSIBLE MECHANISMS OF ANTI-TNF DRUG THERAPY IN CRPS NERVE PAIN

Anti-TNF drugs (e.g. Infliximab, Etanercept) are TNF monoclonal antibodies that selectively block TNF, hence limiting the pro-inflammatory process.

The reduction of TNF and other pro-inflammatory mediators (via anti-TNF drug therapy or otherwise) may alleviate certain painful symptoms in CRPS, sciatica, post-stroke pain and other severe nerve pain conditions.

Ongoing trials are warranted including analysis of side effects.

For further details, please refer to all papers by Edward Tobinick MD and his peers.

Other papers are also available in the References including 24-page Review Paper by Sabina Walker and Prof. Peter Drummond. In particular, please see pages 1790 – 1791, plus related references on page 1804 (included below).

 

REFERENCES

Selected Scientific Publications by Dr Tobinick and His Peers

https://www.nrimed.com/inr-scientific-publications/

(1A) Ignatowski TA et al. Perispinal Etanercept for Post-Stroke Neurological and Cognitive Dysfunction: Scientific Rationale and Current Evidence.CNS Drugs(August 2014); 28(8): 679-697.

https://www.strokebreakthrough.com/wp-content/uploads/PSE.post-stroke.Scientific-Rationale.August2014.pdf

(1B) Tobinick E and Davoodifar S.Efficacy of etanercept delivered by perispinal administration for chronic back and/or neck disc-related pain: a study of clinical observations in 143 patients. Davoodifar S. Curr Med Res Opin(July 2004); 20(7): 1075-85.

https://www.ncbi.nlm.nih.gov/pubmed/15265252

(1C) Tobinick, Edward et al. Immediate Neurological Recovery Following Perispinal Etanercept Years After Brain Injury. Clin Drug Investig(May 2014); 34(5): 361-6.

https://www.ncbi.nlm.nih.gov/pubmed/24647830

(1D) Tobinick, Edward et al.On Overcoming Barriers to Application of Neuroinflammation Research. In: Abreu GEA, ed. Mechanisms of Neuroinflammation: InTechOpen; 2017.

https://www.nrimed.com/wp-content/uploads/Chapter7.overcoming.barriers.pdf

(1E) Tobinick, Edward. Perispinal Delivery of CNS Drugs. CNS Drugs (2016); 30(6): 469-80.

https://www.ncbi.nlm.nih.gov/pubmed/27120182

(1F) Tobinick, Edward. Perispinal etanercept advances as a neurotherapeutic.Expert Review of Neurotherapeutics (2018); 1-3.

https://www.nrimed.com/wp-content/uploads/Perispinal-etanercept-advances-as-a-neurotherapeutic-1.pdf

(1G) Tobinick, Edward. Perispinal etanercept: a new therapeutic paradigm in neurology.

Expert Review of Neurotherapeutics (June 2010); 10(6): 985-1002.

https://www.strokebreakthrough.com/wp-content/uploads/PSE.ERN2_2.pdf

(1H) Tobinick, Edward. Perispinal etanercept for neuroinflammatory disorders.Drug Discovery Today(Feb 2009); 14(3-4): 168-77.

https://www.ncbi.nlm.nih.gov/pubmed/19027875

(1I) Tobinick, Edward et al.Perispinal Etanercept for Traumatic Brain Injury.Chapter 7, pp. 109-29, in New Therapeutics for Traumatic Brain Injury, Cambridge, Mass.: Academic Press. 2017.

https://www.sciencedirect.com/science/article/pii/B9780128026861000079

(1J) Tobinick, Edward et al.Rapid intracerebroventricular delivery of Cu-DOTA-etanercept after peripheral administration demonstrated by PET imaging. BMC Res Notes(27 Feb 2009); 2: 28.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2651903/pdf/1756-0500-2-28.pdf

(1K) Tobinick, Edward L. Targeted etanercept for treatment-refractory pain due to bone metastasis: two case reports. Clinical Therapeutics. (Aug 2003); 25(8): 2279-88.

https://www.ncbi.nlm.nih.gov/pubmed/14512134

(1L) Tuttolomondo et al.Studies of Selective TNF Inhibitors in the Treatment of Brain Injury from Stroke and Trauma: A Review of Evidence to Date. Drug Design, Development and Therapy(Nov 2014); 8: 2221-2239.

https://www.ncbi.nlm.nih.gov/pubmed/25422582

Other Scientific Publications 

(2) Karppinen et al; Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to manage severe sciatica. Spine 2003;28:750–4.

(3) Manning; New and emerging pharmacological targets for neuropathic pain. Curr Pain Headache Rep 2004;8:192–8.

(4) Korhonen et al; The treatment of disc-herniation-induced sciatica with infliximab: One-year follow-up results of FIRST II, a randomized controlled trial. Spine 2006;31:2759–66.

(5) Burnett, Day; Recent advancements in the treatment of lumbar radicular pain. Curr Opin Anaesthesiol 2008;21:452–6.

(6) Cohen et al; Randomized, double-blind, placebo-controlled, dose-response, and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica. Anesthesiology 2009;110:1116–26.

(7) Lipsky et al; Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study group. N Engl J Med 2000;343:1594–602.

(8) Emery, Buch; Treating rheumatoid arthritis with tumor necrosis factor alpha blockade. BMJ 2002; 234:212–213.

(9) Blam et al; Integrating anti-tumor necrosis factor in inflammatory bowel disease: current and future perspectives. Am J Gastroenterol 2001;96:1977–1997.

Scientific Publication by Sabina Walker (Blogger of Pain Matters) and Professor Peter Drummond

(10) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.

In particular, please refer to pages 1790 – 1791, plus related references on page 1804 (also listed above).

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract

External Laser Therapy and Laserneedle Acupuncture for Chronic Pain

Featured Image:   Comb Jelly (Mnemiopsis sp.)

https://i.ytimg.com/vi/weeFO6kLu5o/maxresdefault.jpg

Dear Pain Matters blog readers,

External laser therapy is used to exert various biological/cellular effects in the body including:

• Stimulation of various acupuncture points (via noninvasive, painless Laserneedle acupuncture); and
• Treatment of local damaged areas within the tissue.  Local laser therapy may be done for pain management, rehabilitation and regeneration of damaged tissue.

External laser therapy uses various laser wavelengths (i.e. colours) to penetrate different depths and tissues beneath the skin including:

• Infrared laser (800 – 900 nanometers, ‘nm’; 810 nm, may be used) – 5 to 7 cm depth below the skin;
• Red laser (630 – 680 nm; 658 nm may be used) – 2 to 3 cm depth below the skin.  Red laser can increase cellular activity and blood circulation as well as stimulate immune cells, fibroblasts and mitochondria, leading to regeneration and improved healing including wound healing;
• Green laser  (532 nm) – 0.5 to 1 cm depth beneath the skin.  Green light is largely absorbed by haemoglobin in the red blood cells; and
• Blue laser (405 nm) – 1 to 2 mm depth only.  Blue laser light has anti-inflammatory effects.

External laser therapy can be applied via:

• Single point lasers.  Only one point and 1 wavelength can be used in single point lasers; or
• Laserneedles.  Up to 12 multi-channel lasers/points including different wavelengths/colours/power outputs may be used at the same time (e.g. Weberneedle system, Lasershower).

External laser therapy may treat various painful medical conditions including:

• Spine syndromes/back pain;
• Osteoarthritis;
• Rheumatoid diseases;
• Tendon inflammation;
• Migraine/headache; and
• Trigeminal neuralgia

(Michael Weber MD).

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/external-laser-therapy/

Fibromyalgia:

A study involving laser acupuncture treatment for fibromyalgia patients reported an average Pain Scale of 4.4, post-laser acupuncture (compared to an average Pain Scale of 8.5, pre-laser acupuncture).

Further improvements occurred when laser acupuncture plus intravenous laser was offered to fibromyalgia patients (i.e. average Pain Scale of 2.9, post-laser acupuncture plus intravenous laser, compared to 8.9, pre-treatment).

Both:

• Laser acupuncture; and
• Laser acupuncture plus intravenous laser

were more effective for pain management than medication alone (6.8, post-medication, versus 8.7, pre-medication) and metal needle acupuncture (6.0, post-treatment, versus 8.5, pre-treatment) in fibromyalgia patients (Wieden).

(For more on intravenous laser, please refer to:
http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/intravenous-laser-therapy/.)

Possible Mechanisms:

I urge all interested readers to read Chapter 4 called ‘Rewiring a Brain with Light’, in Norman Doidge’s 2nd book, ‘The Brain’s Way of Healing’.  This book provides an excellent introduction into phototherapy (i.e. low level laser therapy; LLLT) (Doidge, 2016).  

Scientists have recently shown that humans (including the human eye and brain) may detect and perceive a single photon (Tinsley et al, 2016).  This is very interesting as it shows the sensitivity of the human body to the biological (hence potential healing) effects of natural light including its visible wavelengths from 400 to 700 nm (blue to red) and invisible wavelengths from 800 to 900 nm (near infrared).

Summary:

Whilst relatively new (and undergoing further research), external laser therapy and Laserneedle acupuncture may be useful for reducing pain in many chronic pain conditions including fibromyalgia.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

junggebauer@webermedical.com

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

http://www.dr-weber-laser-clinic.com/en/home/

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

(1A) Michael Weber MD

Laser in Pain Therapy and Rehabilitation

http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/pain-therapy-rehabilitation/

http://www.webermedical.com/en/the-business/dr-weber/

http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

(1B) Michael Weber MD, Robert Weber, Martin Junggebauer

Medical Low Level Laser Therapy – Foundations and Clinical Applications (2nd Edition, June 2015)

http://www.isla-laser.org/en/

(1C) Michael Weber MD, President of International Society for Medical Laser Applications (ISLA)

International Society for Medical Laser Applications (ISLA)

http://www.isla-laser.org/en/

(1D) Michael Weber MD, Thomas Fussgänger-May MD, Tillman Wolf MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

http://www.my-dr.de/FG/texte/infounten/Publikationen/Medical_Acupuncture.pdf

(1E) Michael Weber MD, Zulia Frost MD

Multi-Laser Needle Acupuncture and Laser Blood Irradiation Therapy – Clinical Application of Biological Laser Therapy (Pages 1-50)

http://www.metgesacupuntors.org/resources/pdfs/congres_2009/17_30Z_Frost.pdf

Other Papers, Articles and a Blog by Fred Kahn, MD FRCS(C):

(2) Wieden, Torsten E. (MD Anaesthesiologist, Special pain therapy)

e-mail: wieden@schmerzpraxis-celle.de

Fibromyalgia in Pain Therapy – Mechanisms and Treatment Options in Laser Therapy

http://www.isla-laser.org/wp-content/uploads/Fibromyalgia-in-Pain-Therapy.pdf

(3) Pryor, Brian A

Class IV Laser Therapy – Interventional and Case Reports Confirm Positive Therapeutic Outcomes in Multiple Clinical Indications (2009)

http://www1.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/11-12/September/PryorLaserPromotional.pdf

(4) Class IV Laser Therapy – Case Study Reports (Pages 1-39)

http://www.madisonlasertherapy.com/uploads/6/4/3/2/6432749/class_iv_therapy_laser_case_studies_report_2013.pdf

(5) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture Using Laser Needles Modulates Brain Function: First Evidence From Functional Transcranial Doppler Sonography and Functional Magnetic Resonance Imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

http://www.ncbi.nlm.nih.gov/pubmed/15316852

(6) Norman Doidge MD

The Brain’s Way of Healing – Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity (Chapter 4 – Rewiring a Brain with Light)

Publisher: Penguin Publishing Group (26 January 2016)

ISBN: 9780143128373

http://www.normandoidge.com/?page_id=1042

(7) Blog by Fred Kahn, MD FRCS(C), LLLT Specialist

http://fredkahnmd.com/2016/07/12/current-research-on-the-management-of-pain/

(8) Tinsley JN et al

Direct detection of a single photon by humans.

Nat. Commun. 7:12172

doi: 10.1038/ncomms12172 (2016).

http://www.nature.com/articles/ncomms12172

 

 

Can Vagus Nerve Stimulation Decrease Inflammation, Hence Reduce Inflammatory Pain in Some Chronic Pain Patients?

Dear Pain Matters blog readers,

One of the most under-appreciated nerves of our body is the vagus nerve.  In Latin, the word ‘vagus nerve’ literally means ‘wandering nerve’.  (In fact, the words vagrant, vagabond, and vague are all based on the same word, ‘vagus’.)

So what does this vagus nerve do?

Answer:  Too much to answer in a single blog post, that’s for sure!

As such, I will only focus on one function of the vagus nerve (from an ‘inflammation/pain’ perspective).

Persistent localised inflammation is a key component of, and contributes to pain in, many chronic pain conditions including CRPS, rheumatoid arthritis (joint inflammation), and inflammatory bowel disease (Crohn’s disease, ulcerative colitis).

Dr Kevin Tracey’s research –

Dr Kevin Tracey’s team found that stimulation of the efferent vagus nerve (motor branch of the vagus nerve) can significantly curtail, and even block, the release of potentially damaging pro-inflammatory cytokines.  Not only can activation of the efferent vagus nerve protect against organ and tissue damage, but it may also reduce pain caused by inflammation.

Specifically, stimulation of the ‘Cholinergic Anti-Inflammatory Pathway’ including the efferent vagus nerve leads to decreased release of pro-inflammatory mediators including tumor necrosis factor alpha (TNF), hence reduced localised inflammation.

So what??  (you may ask)

In November 2012, Dr Kevin Tracey’s lab reported the first successful clinical trial that showed that stimulation of the vagus nerve can be effective for decreasing inflammation and pain in Rheumatoid Arthritis patients.

This is very exciting news….and it raises further questions….

For example, if stimulation of the vagus nerve can be effective in Rheumatoid Arthritis patients, could stimulation of this same vagus nerve also offer certain relief from inflammatory pain to other chronic pain patients with persistent localised inflammation (including some patients with CRPS, inflammatory bowel disease, etc)?

If yes, could vagus nerve stimulation be offered in addition to, or as an alternative to, current pain treatments?

I look forward to further updates of Kevin Tracey’s clinical study involving stimulation of the vagus nerve in Rheumatoid Arthritis patients.

Any benefits to Rheumatoid Arthritis patients may offer hope and inspiration to some chronic pain patients with persistent inflammation (eg CRPS, inflammatory bowel disease, etc).

Here’s to ‘less chronic pain, more gain’.

Sabina Walker

REFERENCES

Dr Kevin Tracey

(1)  http://www.feinsteininstitute.org/faculty/kevin-j-tracey-md/

(2)  “SetPoint Medical Presents Positive Clinical Results for First Human Study of Implantable Neuromodulation Device for Rheumatoid Arthritis” (12 Nov, 2012).

http://www.businesswire.com/news/home/20121112005932/en/SetPoint-Medical-Presents-Positive-Clinical-Results-Human#.VGQLh4fN6-I

(3A) The Body Electric

http://www.huffingtonpost.com/dr-kevin-j-tracey-md/the-body-electric_b_5396922.html

(3B) …Or click here for interview with Dr Kevin Tracey (if above link does not work):

Dr. Kevin Tracey Explains How A Nerve Stimulator Could Change Arthritis Treatment

http://www.huffingtonpost.com/2014/05/30/nerve-stimulator-arthritis-treatment_n_5420248.html

(4) Can the Nervous System Be Hacked?

By Michael Behar; 23 May, 2014; The New York Times (Magazine)

(5) Fox, Douglas. The Shock Tactics Set to Shake Up Immunology. Nature (04 May 2017); 545: 20–22.

doi: 10.1038/545020a

Click to access 545020a.pdf

Academic papers by Kevin J Tracey (there are now over 315 published papers):

(6) Koopman FA, Chavan SS, Miljko S, Grazio S, Sokolovic S, Schuurman PR, Mehta AD, Levine YA, Faltys M, Zitnik R, Tracey KJ, Tak PP. Vagus Nerve Stimulation Inhibits Cytokine Production And Attenuates Disease Severity In Rheumatoid Arthritis. PNAS (2016); 113(29): 8284-8289.

doi: 10.1073/pnas.1605635113

http://www.pnas.org/content/113/29/8284.abstract

(7) http://www.researchgate.net/profile/Kevin_Tracey/publications

Other References

(8) Bonaz B, Sinniger V, Hoffmann D, Clarençon D, Mathieu N, Dantzer C, Vercueil L, Picq C, Trocmé C, Faure P, Cracowski J-L, Pellissier S. (2016), Chronic Vagus Nerve Stimulation in Crohn’s Disease: A 6-Month Follow-Up Pilot Study. Neurogastroenterol Motil (2016); 28: 948–953.

doi: 10.1111/nmo.12792

https://www.ncbi.nlm.nih.gov/pubmed/26920654

(9) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract

(Our 24-page Review Paper includes extensive discussion of Kevin Tracey’s research and whether this research may be relevant to CRPS.)  

 

Anti-TNF Drugs for CRPS and Other Chronic Pain Conditions (1/2)

Dear Pain Matters blog readers,

Introduction

Infliximab, Etanercept and other selective anti-TNF drugs are sometimes used to treat:

• Complex regional pain syndrome (CRPS);
• Lumbar radicular pain;
• Sciatica;
• Post-stroke pain;
• Rheumatoid arthritis;
• Crohn’s disease; and
• Other painful conditions.

This blog post will explore anti-TNF drugs for CRPS.

A second blog post will explore a single perispinal Etanercept injection for some patients with sciatica, post-stoke pain and other painful conditions.

A SINGLE Perispinal Etanercept Injection Offers Relief from Severe Chronic Pain including Sciatica and Post-Stroke Pain (2/2)

Complex Regional Pain Syndrome (CRPS) and Anti-TNF Drug Trial

Several European studies showed promising results following anti-TNF drug (Infliximab) trials in CRPS patients.

(1) Infliximab Treatment for 2 CRPS Patients 

In the 1st Infliximab paper, pain decreased in 2 CRPS patients.

• 1st Patient (Female, 50):  Chronic CRPS, Duration ~ 5 years
• 2nd Patient (Female, 55): Acute CRPS, Duration ~ 2 months, caused by left arm Colles’ fracture

Blister fluid from the CRPS limbs of both patients showed significant reductions in localised tumor necrosis factor-alpha (TNF) and IL-6 following Infliximab treatment.

More importantly (from the patients’ perspective), there was:

• Reduced pain;
• Decreased vascular disturbances;
• Less swelling/edema;
• Enhanced motor function; and
• Improved symptoms (Huygen et al, 2004).

(2) Infliximab Treatment for 1 CRPS Patient –

In the 2nd Infliximab paper, pain decreased in 1 patient with acute CRPS.  Specifically, a female patient (62) with acute CRPS for 3 months, caused by left hand Colles’ fracture, showed near-complete remission following Infliximab treatment for 8 weeks (Bernateck et al, 2007).

(3) Infliximab Trial for CRPS (7 Cases, Plus Placebo Group) –

Six (6) CRPS patients were treated with Infliximab, while another 7 CRPS patients were given placebo.  There was greater reduction in TNF levels in the Infliximab-treated patients (compared to placebo).  However, for various reasons, this study was discontinued (Dirckx et al, 2013; Nederlands Trial Register 449 ISRCTN 75765780).

Summary

More research into anti-TNF drug treatment for CRPS is warranted.  Such studies should confirm whether localised TNF levels are elevated in CRPS-affected limbs in the first place.  If yes, analysis is necessary whether any anti-TNF drug treatment leads to a significant reduction in these elevated localised TNF levels, and if yes, whether this is also accompanied by reduced pain (etc).  Induced skin blisters or skin biopsies may be necessary to confirm localised TNF levels in CRPS-affected limbs, both ‘before’ and ‘after’ anti-TNF drug treatment.

NOTE:  If localised TNF levels are already low to begin with (prior to anti-TNF drug treatment), anti-TNF drug treatment is (likely) not justified.

Possible adverse effects also need to be considered prior to anti-TNF drug treatment.

 

Wishing all pain patients less pain,

Sabina Walker

PS YOU DON’T HAVE TO READ THE FOLLOWING UNLESS YOU ARE VERY INTERESTED IN SCIENCE –

POSSIBLE MECHANISMS OF ANTI-TNF DRUG THERAPY IN CRPS NERVE PAIN

Anti-TNF drugs (e.g. Infliximab, Etanercept) are TNF monoclonal antibodies that selectively block TNF, hence limiting the pro-inflammatory process.

The reduction of TNF and other pro-inflammatory mediators (via anti-TNF drug therapy, or otherwise) may alleviate certain painful symptoms in CRPS , sciatica and other nerve pain conditions.

Ongoing trials are warranted including analysis of side effects.

For further details, please refer to 24-page Review Paper by Sabina Walker and Prof. Peter Drummond. In particular, please see pages 1790 – 1791, plus related references on page 1804 (listed below).

REFERENCES:

Anti-TNF Drug Therapy For Lumbar Radicular Pain Including Severe Sciatica, Rheumatoid Arthritis, and Crohn’s disease

(1) Karppinen et al; Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to manage severe sciatica. Spine 2003;28:750–4.

(2) Manning; New and emerging pharmacological targets for neuropathic pain. Curr Pain Headache Rep 2004;8:192–8.

(3) Korhonen et al; The treatment of disc-herniation-induced sciatica with infliximab: One-year follow-up results of FIRST II, a randomized controlled trial. Spine 2006;31:2759–66.

(4) Burnett, Day; Recent advancements in the treatment of lumbar radicular pain. Curr Opin Anaesthesiol 2008;21:452–6.

(5) Cohen et al; Randomized, double-blind, placebo-controlled, dose-response, and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica. Anesthesiology 2009;110:1116–26.

(6) Lipsky et al; Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study group. N Engl J Med 2000;343:1594–602.

(7) Emery, Buch; Treating rheumatoid arthritis with tumor necrosis factor alpha blockade. BMJ 2002; 234:212–213.

(8) Blam et al; Integrating anti-tumor necrosis factor in inflammatory bowel disease: current and future perspectives. Am J Gastroenterol 2001;96:1977–1997.

Anti-TNF Drug Therapy For Complex Regional Pain Syndrome (CRPS)

(9) Huygen et al. Successful treatment of CRPS 1 with anti-TNF. J Pain Symptom Manage 2004;27:101–3.

http://www.ncbi.nlm.nih.gov/pubmed/15157033

(10) Bernateck et al. Successful intravenous regional block with low-dose tumor necrosis factor-a antibody infliximab for treatment of complex regional pain syndrome 1. Anesth Analg 2007;105:1148–51.

Click to access Bernateck_Rolke.pdf

(11A) Dirckx, Groeneweg, Wesseldijk, Stronks, Huygen; Report of a Preliminary Discontinued Double-Blind, Randomized, Placebo-Controlled Trial of the Anti-TNF-α Chimeric Monoclonal Antibody Infliximab in Complex Regional Pain Syndrome; Pain Practice (Nov 2013); 13(8):633–640.

DOI: 10.1111/papr.12078

http://onlinelibrary.wiley.com/doi/10.1111/papr.12078/abstract

(11B) Nederlands Trial Register 449 ISRCTN 75765780

http://www.controlled-trials.com/ISRCTN75765780/crps

(12) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.

In particular, please refer to pages 1790 – 1791, plus related references on page 1804 (also listed above).

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract