Etanercept is an injectable medication used to treat various inflammatory conditions. Etanercept modulates the inflammation process by binding to and blocking Tumour Necrosis Factor (TNF) – a cell signalling protein (cytokine) that promotes and mediates inflammation. Increased concentrations of TNF are found in acute and chronic inflammatory conditions, such as rheumatoid arthritis, intervertebral disc disorders and spinal nerve trauma/irritation (radiculopathy).

Etanercept for Pain

In pain medicine, sciatica and low back pain resulting from lumbar radiculopathy may be treated with a transforaminal injection of etanercept. This involves the use of a small spinal needle to deliver etanercept to the inflamed spinal nerve root - the site at which the nerve exits the spinal column (the foramen) – that is causing the radicular pain. The injected etanercept neutralises the increased levels of TNF released from the affected spinal disc or nerve in order to reduce inflammation and provide pain relief. Increased concentrations of TNF have also been associated with pathological changes to the disc; therefore, inhibition of TNF with etanercept may also prevent further degenerative changes to the spine and hence improve physical function.

Procedure Information

A transforaminal etanercept injection is a relatively non-invasive procedure and may be performed in a day surgery setting. The patient is admitted to the day surgery by a nurse and asked to change into a gown. After speaking with an anaesthetist, some sedation is administered via a cannula in the back of the hand. The patient is positioned onto the procedure table lying on their abdomen. An X-ray machine is used to determine the correct spinal needle placement. Transforaminal injection of etanercept to the target spinal nerve root is then performed. The procedure takes approximately 10 minutes to complete.

Because etanercept also acts on the immune system, the injection may affect the body’s ability to fight infections. Signs of an infection include fever, cough and flu-like symptoms and should be reported to the pain clinic.

More information on our injection procedure is available here.

References & Further Reading:

1. Australian Prescriber. Etanercept. 2002:25:20-3. https://www.nps.org.au/australian-prescriber/articles/etanercept
2. Cohen SP, Bogduk N, Dragovich A, et al. Randomized, Double-blind, Placebo-controlled, Dose-response, and Preclinical Safety Study of Transforaminal Epidural Etanercept for the Treatment of Sciatica. Pain Medicine. 2009:110:1116-26. https://www.ncbi.nlm.nih.gov/pubmed/?term=19387178
3. Freeman BJC, Ludbrook GL, Hall S, et al. Randomized, Double-blind, Placebo-Controlled, Trial of Transforaminal Epidural Etanercept for the Treatment of Symptomatic Lumbar Disc Herniation. Spine. 2013:38:1986-94. https://www.ncbi.nlm.nih.gov/pubmed/24165696
4. Genevay S, Finckh A, Payer M, et al. Elevated levels of tumor necrosis factor-alpha in periradicular fat tissue in patients with radiculopathy from herniated disc. Spine. 2008:33:2041-6. https://www.ncbi.nlm.nih.gov/pubmed/18758358
5. Image by Sarah G (Own work) [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)], via flickr: https://www.flickr.com/photos/...