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Drug Discov Today. 2018 Nov;23(11):1904-1909. doi: 10.1016/j.drudis.2018.06.004. Epub 2018 Jun 9.

Why are there no drugs indicated for sciatica, the most common chronic neuropathic syndrome of all?

Author information

1
Department of Neurosurgery, Translational Pain Research Program, University of Rochester, 2180 South Clinton Avenue, Rochester, NY, USA. Electronic address: john_markman@urmc.rochester.edu.
2
Division of Neurological Pain Research and Therapy, Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Haus 41, Arnold-Heller-Strasse 3, 24105 Kiel, Germany.
3
Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, USA.

Abstract

This review examines the stark contrast between the successes and failures of the clinical development of analgesics for different types of chronic low back pain (CLBP) syndrome over the past three decades. Multiple drugs with differing mechanisms of action have been developed for nonspecific axial-predominant low back syndromes and yet not a single therapy is indicated for any neuropathic low back pain syndrome (e.g., sciatica). Clinician findings have informed the entry criteria for neuropathic low back pain clinical trials, whereas entry criteria of axial CLBP trials have prioritized only patient reports of pain. This key difference could account for the lack of success in developing therapies for neuropathic low back pain in an era marked by successful development of analgesics for other types of CLBP as well as many chronic pain syndromes associated with nerve injury, such as post-herpetic neuralgia (PHN).

PMID:
29894812
DOI:
10.1016/j.drudis.2018.06.004
[Indexed for MEDLINE]

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