New Trials in Pharmacological Treatment of Radicular Pain: Based on Pathophysiology

摘要

Recent studies demonstrated that intervertebral disc herniation can be asymptomatic unless accompanied by irritation of nerve root, and the mechanical compression may not be the only cause of painful radiculopathy. In animal studies, it has been shown that nucleus pulposus alone can induce radiculopathy, as well as increases susceptibility of compressed nerve roots. A lot of chemical mediators including nitric oxide, interleukins, tumor necrosis factor alpha (TNF-alpha), and other cytokines, are known to be involved in this biochemical part of pathologic mechanism. Evidences demonstrating contribution of chemical reaction made more clinicians interested in non-surgical treatment. Medications such as corticosteroids, anti-inflammatory agents, specific inhibitors of chemical mediators and antioxidants are being under trial to arrest the chemical irritation of nerve roots.