Back study deals blow to pain drug etanercept

Our aching backs still can't get a break.

The genetically engineered drug etanercept, hailed as a breakthrough in safe pain management, is no more effective in the long term than other back pain treatments, research published Monday in the Annals of Internal Medicine finds.

Back pain torments nearly two-thirds of Americans and is the leading cause of disability in people 45 and younger. Physicians have used epidural steroid injections to treat sciatica, pain radiating from the back into the buttocks and legs. But it has mixed results and can have dangerous side effects, including hip arthritis, stomach ulcers and a decrease in immunity. Etanercept, sold by the brand name Enbrel, does not pose those risks.

"This treatment has generated a lot of hype because specialists have been desperate for a safe way to treat back pain," says lead author Steven Cohen, director of pain research at Walter Reed National Military Medical Center. "But it's turning out to be a big disappointment in this study."

In the study, 84 people were divided into three groups and given injections of either steroids, etanercept or saline (a placebo); they were not told which they were given. They were followed for six months, after injections two weeks apart.

At one month, patients on steroids reported greater leg pain relief and felt better overall than those getting saline solution or etanercept. But after six months, slightly more patients in the saline and etanercept groups had a more positive outcome than those in the steroid group.

Cohen says future studies need to see whether higher doses of etanercept are safe, "but for the dose deemed safe, so far, it's not panning out."

Daryll Dykes, spokesman for the American Academy of Orthopedic Surgeons, who was not involved in the study, says many people with back pain "do heal on their own without treatment. But for the people who suffer from this kind of pain, and it can be intense, it is important to know studies are looking at different options."

"Some people can roll over the wrong way in bed and herniate a disc," he says. "Others might do it sneezing," and genes may also play a role.