New treatment of lumbar disc herniation involving 5-hydroxytryptamine2A receptor inhibitor: a randomized controlled trial

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Serotonin or 5-hydroxytryptamine (5-HT) is a chemical mediator associated with nucleus pulposus—induced radiculopathy. Inhibition of 5-HT receptors may potentially alleviate symptoms in patients with lumbar disc herniation. This prospective randomized controlled study was performed to evaluate the efficacy of the 5-HT<jats:sub>2A</jats:sub> receptor inhibitor in the treatment of symptomatic lumbar disc herniation.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Forty patients with sciatica due to L4–5 or L5—S1 disc herniation were randomly allocated to treatment with the 5-HT<jats:sub>2A</jats:sub> inhibitor (sarpogrelate 300 mg/day) or nonsteroidal antiinflammatory drugs (NSAIDs; diclofenac 75 mg/day). Low-back pain, leg pain, and numbness were evaluated using a visual analog scale (VAS) before and after a 2-week course of treatment. The patients received only allocated medicine during the 2-week regimen and were thereafter allowed to choose any treatment options depending on their residual symptoms. One-year clinical outcomes were assessed based on the rates of additional medical interventions.</jats:p> <jats:p content-type="fine-print">The mean VAS score improvements in the 5-HT<jats:sub>2A</jats:sub> and NSAID groups were 33 and 46% for low-back pain, 32 and 32% for leg pain, and 35 and 22% for leg numbness, respectively. After the 2-week regimen, no additional medical interventions were required in 50% of 5-HT<jats:sub>2A</jats:sub>—treated patients and 15% of those receiving NSAIDs. Epidural or nerve root block procedures were performed in 35% of the 5-HT<jats:sub>2A</jats:sub> group and 45% of the NSAID group. Surgery was required in 20% of the 5-HT<jats:sub>2A</jats:sub> group and 30% of the NSAID group patients.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The current study provided evidence that the efficacy of the 5-HT<jats:sub>2A</jats:sub> inhibitor was comparable with that of NSAID therapy for lumbar disc herniation. The 5-HT<jats:sub>2A</jats:sub> inhibitor has the potential to alleviate symptoms in patients with lumbar disc herniation.</jats:p>

Assessment of Pain Sensitivity in Patients With Chronic Low Back Pain and Association With HTR2A Gene Polymorphism

“…10 Kanayama et al 9 studied the efficacy of 5-HT2A receptor antagonists in patients with symptomatic lumbar disc herniation with and without disc extrusion. They reported that the 5-HT2A receptor antagonists were effective in treatment of patients without disc extrusion while they were not effective in patients with extruded disc.…”

“…8 Indeed, serotonin specific reuptake inhibitors have been successfully used to treat CLBP. 9,10 Moreover, it was reported that an important portion of CLBP patients have concomitant fibromyalgia. 11 However, to date, the abnormalities in the serotonergic system and the variation in genes that are involved in 5-HT synthesis and potentially associated with the extent of the pain have not been studied in patients with CLBP.…”

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

“…Three studies 161,172,226 did not report any pain, global or CSOM data. 161,172,226 Fifteen studies compared different types of non-opioids 223,227,229,[231][232][233][234][235][236][237][238][239][240][241] (seven of which were three-arm studies 57,215,223,227,229 and two studies of which were reported in a single publication 223 ). The types of non-opioids being compared are presented in Table 45b but the findings are not considered further.…”

Effects of the 5-HT2A Antagonist Sarpogrelate on Walking Ability in Patients with Intermittent Claudication as Measured Using the Walking Impairment Questionnaire

“…The incidence of adverse reactions in our study was 4.83%, which is not significantly higher than the combined incidence in the clinical trials and postmarketing surveillance (2.23%; 107/4,807). 28) There were no clinically significant safety concerns clearly linked to the drug, confirming the good tolerability of this agent. Disease severity can be assessed noninvasively by ABI.…”