{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:35:41Z","timestamp":1791905741348,"version":"4.3.4"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Anesthesiology"],"published-print":{"date-parts":[[2009,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent evidence implicates the inflammatory cytokine tumor necrosis factor as a major cause of radiculopathy. Yet, whereas open-label studies with systemically delivered tumor necrosis factor inhibitors have yielded positive results, a placebo-controlled study failed to demonstrate efficacy. One variable that may have contributed to poor outcomes is low drug levels at the site of nerve inflammation. To date, no studies have evaluated the efficacy or safety of epidurally administered anti-tumor necrosis factor agents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A double-blind, placebo-controlled, dose-response study was conducted to evaluate an epidural tumor necrosis factor inhibitor. Twenty-four patients with subacute lumbosacral radiculopathy were randomly assigned to receive two transforaminal epidural injections of 2, 4, or 6 mg of entanercept 2 weeks apart in successive groups of eight. In each group, two patients received epidural saline. A parallel epidural canine safety study was conducted using the same injection doses and paradigm as in the clinical study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The animal and human safety studies revealed no behavioral, neurologic, or histologic evidence of drug-related toxicity. In the clinical arm, significant improvements in leg and back pain were collectively noted for the etanercept-treated patients, but not for the saline group, one month after treatment. One patient in the saline group (17%), six patients in the 2-mg group (100%), and four patients each in the 4-mg and 6-mg groups (67%) reported at least 50% reduction in leg pain and a positive global perceived effect one month after treatment. Six months after treatment, the beneficial effects persisted in all but one patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Epidural entanercept holds promise as a treatment for lumbosacral radiculopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/aln.0b013e3181a05aa0","type":"journal-article","created":{"date-parts":[[2009,5,21]],"date-time":"2009-05-21T11:45:31Z","timestamp":1242906331000},"page":"1116-1126","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":118,"title":["Randomized, Double-blind, Placebo-controlled, Dose-response, and Preclinical Safety Study of Transforaminal Epidural Etanercept for the Treatment of Sciatica"],"prefix":"10.1097","volume":"110","author":[{"given":"Steven\u00a0P.","family":"Cohen","sequence":"first","affiliation":[{"name":"COL S. Cohen, Associate Professor, Departments of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, and Walter Reed Army Medical Center (WRAMC), Washington, D.C.."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Bogduk","sequence":"additional","affiliation":[{"name":"Professor, Newcastle Bone & Joint Institute, Newcastle, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Dragovich","sequence":"additional","affiliation":[{"name":"MAJ. A. Dragovich, Director of Pain Clinic, Womack Army Medical Center, Fort Bragg, North Carolina, and Assistant Professor, Department of Anesthesiology, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chester\u00a0C.","family":"Buckenmaier","sequence":"additional","affiliation":[{"name":"COL. C. Buckenmaier, Director, Army Regional Anesthesia & Pain Management Initiative, Walter Reed Army Medical Center, and Associate Professor, Department of Anesthesiology, USUHS."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Griffith","sequence":"additional","affiliation":[{"name":"MAJ. S. Griffith, Director, Pain Clinic, WRAMC, and Assistant Professor, USUHS."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Kurihara","sequence":"additional","affiliation":[{"name":"Research Nurse, Pain Treatment Center, WRAMC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoLynne","family":"Raymond","sequence":"additional","affiliation":[{"name":"COL. J. Raymond, Senior Veterinary Pathologist, Armed Forces Institute of Pathology, Washington, D.C.."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip\u00a0J.","family":"Richter","sequence":"additional","affiliation":[{"name":"Associate Clinical Professor, Department of Pathology, University of California, San Diego, San Diego, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Necia","family":"Williams","sequence":"additional","affiliation":[{"name":"CDR. N. Williams, Chief, Anesthesia & Operative Services, Combined Walter Reed National Medical Center, Bethesda, Maryland, and Assistant Professor, Department of Anesthesiology, USUHS."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony\u00a0L.","family":"Yaksh","sequence":"additional","affiliation":[{"name":"Professor, Department of Anesthesiology, University of California, San Diego, San Diego, California."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-28-20251013"},{"key":"R2-28-20251013"},{"key":"R3-28-20251013"},{"key":"R4-28-20251013"},{"key":"R5-28-20251013"},{"key":"R6-28-20251013"},{"key":"R7-28-20251013"},{"key":"R8-28-20251013"},{"key":"R9-28-20251013"},{"key":"R10-28-20251013"},{"key":"R11-28-20251013"},{"key":"R12-28-20251013"},{"key":"R13-28-20251013"},{"key":"R14-28-20251013"},{"key":"R15-28-20251013"},{"key":"R16-28-20251013"},{"key":"R17-28-20251013"},{"key":"R18-28-20251013"},{"key":"R19-28-20251013"},{"key":"R20-28-20251013"},{"key":"R21-28-20251013"},{"key":"R22-28-20251013"},{"key":"R24-28-20251013"},{"key":"R25-28-20251013"},{"key":"R26-28-20251013"},{"key":"R27-28-20251013"},{"key":"R28-28-20251013"},{"key":"R29-28-20251013"},{"key":"R30-28-20251013"},{"key":"R31-28-20251013"},{"key":"R32-28-20251013"},{"key":"R33-28-20251013"},{"key":"R34-28-20251013"},{"key":"R35-28-20251013"},{"key":"R36-28-20251013"}],"container-title":["Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.asahq.org\/anesthesiology\/article-pdf\/110\/5\/1116\/533055\/0000542-200905000-00028.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.lww.com\/00000542-200905000-00027","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T16:18:24Z","timestamp":1760372304000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00000542-200905000-00027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,5,1]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2009]]}},"URL":"https:\/\/doi.org\/10.1097\/aln.0b013e3181a05aa0","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.1161917.622352","asserted-by":"object"}]},"ISSN":["0003-3022"],"issn-type":[{"value":"0003-3022","type":"print"}],"subject":[],"published":{"date-parts":[[2009,5,1]]}}}