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Enbrel very effective for back pain

Discussion in 'Male Health & HRT' started by seekonk, Sep 16, 2010.

  1. seekonk

    seekonk Active Member

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    For my fellow sufferers, these guys are having amazing results with Enbrel injections for back pain. The injections are just subQ.

    The full article is here: http://www.smw.ch/docs/pdf200x/2003/11/smw-10163.pdf

    See also the other publications here: http://www.tobinick.com/

    From the article

     
  2. Picton

    Picton Super Moderator Staff Member Super Moderator

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    A colleague of a close fried of mine is undergoing a trial of this at the moment (Ankylosing spondylitis), so I read this with great interest, especially bearing in mind my own back pain problems, but instantly shrank away when I realised the tone of the study was anti-opiate :-(

    Here we go again. I have been reading this sort of thing for as long as I have had internet access, about 16 years now.

    It's like all those anti-TRT studies are obsessed with keeping genuine Hypogonadism patients away from Testosterone, as that is in some way "not right" it has a pre-set agenda - in this case the usual one of "get them off the opiates" - and consequently I wouldn't believe a word it said if it told me that night follows day! :-(

    Why does a drug study have to even mention the word opiate at all, especially as it is not a specific analgesic itself?

    Maybe it does work well in general, but of course it won't work in ALL situations, (for one thing, it will require the cause of the pain to be genuinely from disc damage or degeneration, and all too often getting any sort of accurate diagnosis escapes pain sufferers) but of course it means those people who do NOT respond to it will become just drug-seekers instead of those in genuine need of pain relief, and I can see even more scripts for Anti-depressants being written out as I write this - "it's all in your mind!".

    Odd how a widely tolerated class of drugs as Opiates gets such a bad press, when more EXPENSIVE newly patented drugs with SPECTACULAR lists of serious side effects gets touted as the solution to everything!

    Cynical? You bet
     
  3. Picton

    Picton Super Moderator Staff Member Super Moderator

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    Interesting this other Publication from the same author:
    http://www.ncbi.nlm.nih.gov/pubmed/19330170
    "The value of drug repositioning in the current pharmaceutical market."

    Hmm, so that's his job - Maximising income from existing drugs.
     
  4. longrob

    longrob Member

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    I have persistent lower muscle back pain. Enbrel seems only to apply to spinal injury/pain, right?
    Rob
     
  5. cpeil2

    cpeil2 Active Member

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    Opiates seem to work for you. They relieve your pain and you have no objection to the physical dependence that results from taking them long term, and apparently you suffer no obnoxious side effects from them. I think you should continue something that works so well for you.

    I'm not sure I can say "most people", but certainly, a lot of people don't like opiates. I don't. They work pretty well, but they turn me into a vegetable. A lot of people have this complaint.

    I dislike opiates so much that I would rather undergo an epidural steroid injection every few months. That would be hassle enough for anybody, but for me it's worse than that - I take an oral anticoagulant and for several days before and after the injection I have to go on bridge therapy with an injected anti-coagulant, then back to the oral drug. Try doing that three times/year. But I do it happily because I hate opiates that much.
     
  6. Picton

    Picton Super Moderator Staff Member Super Moderator

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    It is an entirely American thing.

    The rest of the world uses them and has no more problems with them than any other drug, despite most places having LESS opiate abuse than in the US.
     
  7. Picton

    Picton Super Moderator Staff Member Super Moderator

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    It seems very specific forms of damage and injury only.
     
  8. cpeil2

    cpeil2 Active Member

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    I simply don't believe that it is an entirely American thing to have obnoxious side effects from opiate drugs.
     
  9. seekonk

    seekonk Active Member

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    No, I don't think it is a bias. It is simply one common way of measuring outcome. A successful intervention would reduce the patient's need for analgesia medications, which is why they mention this. For this reason, reduction in the need for opiates is a common measurement endpoint in pain studies.

    Also, if you read some of the case reports, opiates have failed for these patients. In other words, they were in a lot of pain, or had a lot of disability, despite opiates. This is my case. The maximum of 8 tramadols a day don't work for me any more. These days I can get up to a seven out of 10 pain while on tramadol. And the tramadol gives me some level of sexual dysfunction, and you know better than I the problems they cause with the hormonal system, so I would love to be off them.

    The Enbrel therapy they mention seem to be as close to a "cure" as can be hoped for. Notice the various patients who were esssentially cured from their pain or disability with in some cases just a single injection. As they explain in one of the papers, almost everybody has some level of degenerative disc disease after age 40, yet only a minority get persistent pain, so this chronic pain can be seen as a neural abnormality separate from the actual disc degeneration. For some reason, TNF blockers such as Enbrel seem to be very effective in resolving the mechanism behind this neural disturbance and providing long term or perhaps even permanent relief, taking you into the normal category of people with some damage but no chronic pain.

    So, the choice is between what is essentially a cure on the one hand, and on the other hand chronic therapy with opioids. My choice is clear. I would much rather be cured.
     
  10. seekonk

    seekonk Active Member

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    It is in many cases only a single injection costing about $100 providing long term relief.

    The side effects are non-existent. (Those noted in the warnings are for people with RA who typically take double that amout every week, and even then only a very small percentage have sides.)

    Compare that to taking opiates long term.
     
  11. seekonk

    seekonk Active Member

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    The best thing about his therapy is that it is not epidural - the injection is subQ. For someone like me who got nerve damage from an epidural injection, this is good news.

    It also seems to work in many cases where steroids failed to provide long term relief. :party:

    Now if only I can find someone to do this for me closer to me than Cali. Dr Crisler (hint, hint)?
     
    Last edited: Sep 16, 2010
  12. cpeil2

    cpeil2 Active Member

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    I would give it serious thought. I am going to bring it up with the chronic pain interventionist when I go in for my upcoming ESI next week. I would also travel to SoCal to see these guys. How much could it cost? Total cost of an ESI for self-pay patients is, I think, usually $1000.00 How could the enbrel injection cost more than that?
     
  13. Picton

    Picton Super Moderator Staff Member Super Moderator

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    No, the great concern is an American thing. It appears to be all based on the addiction issue.

    If you want an addictive drug group to worry about.. worry about Benzodiazipines..... the Valium & Librium junkies still stalk the corridors of medical establishments from the misuse of decades which STILL goes on, despite better drugs existing with less side effects! Temazepam is a bigger street drug here than opiates, and it scares me far more, they are often sourced from prescribed sources, which I can't sensibly explain!

    That said, I have never personally met anyone with any serious reaction to ANY opiate properly prescribed & administered, yet other widely used analgesic drugs such as Ketamine don't do so well in comparison, although they too have their place! What I have found is failure to respond therapeutically to opiates, which is quite common.

    Now, I would be worried to death if I was going to be addicted to something handed out freely to ease a headache after 5 doses, (not that ANY Opiate is that addictive, it simply is not like that); but it is not of ANY concern to me that I might become addicted to something used to treat an INCURABLE condition, I won't be losing the pain, so I won't WANT to stop the Opiate! Being addicted is effectively the same as a Diabetic is "addicted" to Insulin, or indeed in that sense I am also "addicted" to testosterone - take it away and I still have the problem, so I HAVE to take it, a nominal addiction seems a bit irrelevant, unless you believe in miracles!

    Unlike on TV, Opiate users are not routinely hallucinating or grossly overdosing. If it happens that regularly in the US, I can't explain it, maybe it is the willingness of Doctors to over-prescribe it for a fee (Michael Jackson's terminal medical assistance comes to mind when I think of odd prescribing practice!) but it doesn't happen here, most times you will get it if you NEED it, (OK, it won't be handed out easily) and also there will be no witch hunt by Police or anyone else, and it also appears to work like that in most of the rest of the world too. Use of opiates for 30 years and more is commonplace, most people hold down normal jobs, in fact it is the ONLY way some hold down ANY part of a normal life.

    Yes people = individuals have problems, as with any drug. Aspirin is a drug that kills MANY every year, but no-one gets too worked up about that! One thing for sure, there is NOTHING even close to the problems Enbrel exhibits!

    Because of the side effect potential of Enbrel, using it for pain relief is like using Caustic soda for a handwash soap, yes it will do the job, but slight overkill is putting it mildly!
     
  14. seekonk

    seekonk Active Member

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    I was just referring to the cost they would pay for the drug. I am sure the injection in their clinic would be expensive.
     
  15. Picton

    Picton Super Moderator Staff Member Super Moderator

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    http://www.askapatient.com/viewrating.asp?drug=103795&name=ENBREL

    Remember it is a very little used drug so far, so saying it is early days is an understatement!

    MILLIONS take Opiates every day. You bet there are side effects.
    There are side effects from drinking TEA when you get to those numbers!
     
  16. seekonk

    seekonk Active Member

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    No, it is in many cases a single injection, in most cases less than 5, having less side effects than opiates (i.e., no side effects in any of the patients they have treated in the studies).

    It is out of your system in a couple of days, yet provides long term relief in many.

    So if it is a choice between essentially being cured by the Enbrel or taking the opiates long term and not getting any better.
     
  17. seekonk

    seekonk Active Member

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    Remember that RA patients take 1 or 2 injections every week forever. Their side effects cannot be compared to the therapy for back pain described here, which provides long term relief for a majority with 1-3 injections in total.
     
  18. cpeil2

    cpeil2 Active Member

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    I checked - $4500. Too rich for my blood. I called to see about scheduling an appointment. They charge $300 for an initial evaluation. I googled it and they showed up on a few message boards reporting medical scams. Supposedly, after the $300.00 evaluation, the doctor issues a treatment recommendation and informs you that the charge will be $4200. The scheduler on the phone told me about the $300 but wouldn't say what the fee for treatment was.

    Even if it is a legitimate treatment and the scam reports are bogus, I think $4500 for a sub-q injection is exorbitant. I'll ask my pain interventionist if he can do it for me. Since it is not a widely accepted treatment, I doubt whether they will, but I will keep it in the back of my mind.
     
  19. seekonk

    seekonk Active Member

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    I agree that there is a problem in America with hysteria about drugs.

    But, in my experience, doctors here overprescribe opiates and benzos, rather than the opposite.

    I have been on first Vicodin then Tramadol at max doses for more than a year. I have no problem getting my scripts refilled every time I run out, and I'm sure my doctors would have no problem keeping me on for 10 years if needed.

    I am the one who wants to get off because of sexual and hormonal side effects and, most importantly, because they don't work very well for me.
     
  20. seekonk

    seekonk Active Member

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    Thank you. Yes, that is indeed astronomical, and the coyness about the fee rings some alarm bells.

    If I could get my hands on the drug, I would have an anaesthesiologist friend do it. Unfortunately, this is one of those drugs that are very difficult to obtain offshore. So I am going to have to beg my orthopedist for it. Like you doctor, I doubt he'll want to. :(
     

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