Could This Drug Be the Next Big Thing in Back Pain Treatment?

New medications such as tanezumab may provide options for treating back pain. Is it available? Is it effective? Is it right for you? Learn more about tanezumab for back pain.

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Finding a major treatment for back issues isn't just about alleviating your pain. It could be a game changer for significantly improving your mobility, boosting your productivity, addressing emotional your health, expanding the breadth of your employment opportunities, and cultivating more graceful aging.

Tanezumab may be the next big thing in back pain treatmentIs tanezumab the next big thing in back pain treatment?

The next big back pain treatment could have that kind of ripple effect across all aspects of your life—and even though we might not be there yet, the medical field may be about to take one step closer.

"Back pain, in particular, is challenging because it truly affects so many aspects of life, and that's why we have to keep looking for solutions for those people having chronic issues," says Kaliq Chang, MD, interventional pain management specialist of the New York- and New Jersey-based Atlantic Spine Center. "It's been decades since we had a real breakthrough. But we may be on the verge of one."

Tanezumab: a Potential Game Changer

Currently in a phase 3 clinical trial—the second-to-last phase—tanezumab is an injectable drug that contains monoclonal antibodies, which are laboratory-produced versions of specific proteins that can be manipulated to follow certain actions. In this case, they work by selectively targeting, binding to, and inhibiting nerve growth factor (NGF), which has been associated with elevated pain levels.

"At this point, we know a lot about the pathways of pain and inflammation signaling with back and neck pain," says Dr. Chang. "The focus of biological researchers like those working on Tanezumab is on blocking the action of NGF without negatively impacting overall function or creating a larger problem than it's solving."

NGF Mysteries

A big part of why that's tricky is because researchers don't know everything that NGF does, beyond pain signaling and communicating with different neurons. Researchers do know that NGF levels surge in the body as a result of injury, inflammation, and chronic pain, and the hope is that by neutralizing NGF, tanezumab would keep pain signals from reaching the spinal cord and brain.

The impact of that process is what's being studied, along with patient safety and treatment efficacy, but it's certainly on the fast track for getting insights on those issues. Dr. Chang anticipates that the Food and Drug Administration (FDA) will approve tanezumab for certain uses within the next few months, which means it could go into production as early as the beginning of 2021.

Tanezumab inhibits nerve growth factor, or NGFTanezumab inhibits nerve growth factor, or NGF

"If approved, this would be a welcome alternative to the medications that are currently available, since those are often not fully effective, especially for chronic issues," he says. "It would also be the first truly new drug for this kind of pain in a long time, as opposed to treatments involving options like surgery."

The phase 3 trial underway is evaluating use of the drug in patients with moderate-to-severe osteoarthritis, which can often bring considerable neck and back pain. But, like many drugs approved for specific conditions, its usage may broaden out over time.

Slow Progress and Remaining Challenges

Even when it does get the FDA's green light, tanezumab likely isn't for every patient with back pain, Dr. Chang says. In fact, it may be appropriate for only a small selection of patients, considering that the issue is so common. The World Health Organization estimates the lifetime prevalence of non-specific low back pain is about 60 to 70 percent in industrialized countries, enough for the issue to be included among the top 10 medical problems in the world.

Most back pain incidents are known as acute back pain, like a pulled muscle or injury, and that often gets better on its own, or with minimal intervention like alternating between ice and heat, according to Dr. Chang. When that becomes more chronic and doesn't respond to conservative treatment, including simple surgery and physical therapy, it becomes refractory back pain.

This is when interventional pain management treatments must be introduced, like spinal cord stimulation, in which a small device is placed under the skin and sends a mild electric current into the spine to block pain signals.

Even this may not work, however. For example, a study done in Ireland on 53 participants with refractory back pain who were not candidates for SCS or who had tried it without relief found some benefit from neurostimulation. But that involves electrodes implanted in the brain, a procedure that's not without risks. Even with that, nearly half showed no improvement in certain pain measures. That's why doctors like Dr. Chang are hoping for the next big treatment to be an effective drug that's less addictive than current options.

Tanezumab could be an alternative or adjunct to existing treatment options for chronic low back pain. Importantly, patients with chronic low back pain should also be evaluated for imaging evidence of focal instability or degenerative disease, which could be improved with surgery. Decompressive and fusion options for selected patients with chronic low back pain can be an excellent option.

In terms of medications, a range of options has been tried, from opioids to anti-inflammatories, but none are completely successful, says Dr. Chang. Those that do work for some patients might become less helpful over time. Not surprisingly, opioids now come with extensive limitations for providers, and the Centers for Disease Control and Prevention's checklist for prescribing them for long-term pain includes setting criteria for stopping their use even before they're first given.

As all these options are tried and abandoned if they don't work, that's when tanezumab would come in as a treatment. Although that means the patient pool for the drug might be much smaller, it could be something of a holy grail for those with refractory pain that simply doesn't respond to anything else, according to Dr. Chang.

"This may be most appropriate at the endpoint for some patients, the ones who are miserable all the time and getting more and more immobile," he says. "It's possible that tanezumab will find its way to a wider group once it's on the market, but for now, we're hoping this will be an option for those who are truly struggling with quality of life because of back pain."

 

Updated on: 09/03/20
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Michael G. Fehlings, MD, PhD, FRCSC, FACS
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