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I'm managing my low back pain with Tylenol and naproxen but it's starting to creep up on me. I don't want to take a narcotic. I heard there is a new nonnarcotic drug called tanezumab that is supposed to cut off nerve pain signals. Would something like that help me? Is it better than what I'm already using?

Chronic low back pain remains a problem without a good solution. No single type of treatment works for everyone. Most patients end up combining multiple different treatments until they find the right mix that is effective for them. This may include medications, counseling or behavioral therapy, physical therapy, and surgery. Medications often include pain relievers (analgesics) such as tylenol and antiinflammatories such as ibuprofen, naproxen, or other prescription nonsteroidal antiinflammatories (NSAIDs). Sometimes mild narcotics such as codeine or tramadol are prescribed. A new drug called Tanezumab developed as a treatment for pain has been shown effective in patients with osteoarthritis, interstitial cystitis (bladder pain), and bone pain from cancer. Tanezumab is a monoclonal antibody (mAb) that works to alleviate pain because it neutralizes nerve growth factor (NGF). Nerve growth factor sets up pain signals and even heightens the body's responsiveness to painful stimuli. This means the nervous system responds faster to smaller inputs creating larger pain responses. Tanezumab stops nerve growth factor activity. Results of a recent U.S. study may be of interest to you. Over 200 patients with chronic low back pain caused by osteoarthritis were included in the study. They were randomly divided into three groups. Group one received a single intravenous dose of (real) tanezumab and a placebo (sugar pill) naproxen (antiinflammatory). Group two were given an intravenous tanezumab placebo with real naproxen. Group three received placebo tanezumab and placebo naproxen. Group one was labeled the tanezumab group. Group two was the naproxen group. And group three was the placebo group. The patients each kept a daily electronic diary recording pain levels and the use of any "rescue" medication. Rescue medication refers to any pain reliever used when painful symptoms were intolerable. Pain intensity and rescue meds were two of the measures used before and after to compare results. Questionnaires were also used to measure function and disability. The effectiveness of tanezumab for chronic low back pain was measured using these outcomes. Safety was also a concern and was assessed by reviewing adverse effects reported by the patients. Review and analysis of the data showed that everyone in all three groups had measurable pain relief. The tanezumab group had the best results, naproxen second best results, and placebo ranked third after the other two. These were the results during the early weeks (zero up to six weeks). After eight weeks, the naproxen and placebo groups were equal. The tanezumab group continued to report the best results throughout the 12 week treatment period. That answers the question of efficacy or effectiveness -- tanezumab clearly outperformed the other two (naproxen and placebo). What about safety? What were the side effects (if any) in the tanezumab group and how did they compare to the other two groups? There were reactions in all three groups but the tanezumab-treated group did have the highest incidence of problems. Joint pain, headaches, muscle pain, and painful responses to stimuli (e.g., touch) that shouldn't be perceived as painful were reported in the tanezumab group. These side effects were temporary and all gone by the end of the study. No one in any of the groups had serious complications (i.e., permanent paralysis or death). Overall, tanezumab provided better pain relief and resulted in better function than either naproxen or placebo. Adverse side effects of the tanezumab were mild-to-moderate and temporary. The problem is that studies using tanezumab were halted in June 2010 when some patients with osteoarthritis got much worse after taking tanezumab and ended up needing hip replacements. If/when the ban on its use in studies is lifted, then its use with chronic low back pain can be further evaluated. Long-term studies are needed to see if recurrence of back pain (common among back pain sufferers) can be changed with tanezumab and if there are any long-term side effects such as bone necrosis. The possibility of having an effective nonnarcotic medication for patients with chronic low back pain that has been unresolved with other treatments is worth pursuing.

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