Saturday 27, Aug 2011
Biomarker useful in testing effectiveness of back pain treatment
A new study from researchers at the Stanford University School of Medicine has identified a unique protein complex that can be used for predicting whether an epidural steroid injection will help relieve pain caused by a herniated disc in the lower spin.
Gaetano Scuderi, MD, a clinical assistant professor of orthopedic surgery was the senior author of the study to be published in the Aug. 15 edition of Spine.
From Med.stanford.edu:
The researchers found that when a molecular complex of fibronectin and aggrecan — protein fragments associated with degenerated or traumatized cartilage — are not present near the hernia, steroid injections almost never work. However, when the complex is present, the injections often provide significant relief. In such cases, the authors hypothesize that the steroid injection interrupts the inflammatory process initiated by the fibronectin-aggrecan complex.
The study enrolled 26 patients — 19 men and seven women — over the course of a year. Of the 14 whose test samples contained the fibronectin-aggrecan complex, 12 responded to an epidural steroid injection and two did not. Of the 12 whose samples did not contain the complex, only one responded to the injection.
“We believe that the biomarker complex identified represents a bona fide and independent indicator of [epidural steroid injection]-responsive patients,” the authors write, noting that larger trials are warranted.
There are challenges to developing this finding for practical use. As it stands, testing for the protein complex is “a technically challenging clinical procedure” that is “as invasive as the injection itself,” the authors write. It requires a tube to be inserted into the outermost part of the spinal canal. Scuderi noted that the procedure also costs about as much as a single steroid injection. However, he said there may be a way to develop a cheaper, simpler sampling method — possibly by creating a blood test or using molecular imaging.
“There’s about a 50-50 chance that the epidural steroid will work, so most people figure, ‘Hey, I have nothing to lose,’” Scuderi said. “However, there is a significant expense, not to mention the procedural risks and lost productivity.”
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