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Saturday, February 26, 2005

Serotonin inibitor effective as NSAID for herniated disc

Serotonin 5-HT2A receptor inhibitor has the potential to alleviate symptoms in lumbar disc herniation and to be an alternative to non-steroidal anti-inflammatory drugs (NSAIDs), according to researchers for Poster Exhibit P306.

Serotonin is a chemical mediator associated with pain production in lumbar disc herniation. Investigators sought to determine if inhibition of serotonin receptors had the potential to alleviate symptoms in lumbar disc herniation. They conducted a prospective, randomized and controlled study comparing the efficacy of serotonin 5-HT2A receptor inhibitor and NSAIDs in lumbar disc herniation.

In the study, 40 patients with sciatica due to L4-L5 or L5-S1 disc herniation were randomly allocated to treatment with a 5-HT2A receptor inhibitor (sarpogrelate, 300mg/day) or an NSAID (diclofenac, 75mg/day). Low back pain, leg pain and numbness were evaluated using visual analog scale (VAS) before and after the treatment. Patients received only the designated medicine during the two-week regimen, and thereafter were allowed to choose any treatment options depending on residual symptoms. One-year clinical outcomes were assessed by the rates of required additional medical interventions.

In the group that received 5-HT2A receptor inhibitor, researchers found average VAS improvement of 33 percent in low back pain, 32 percent in leg pain, and 35 percent in leg numbness. VAS improvement in the group that received NSAIDs averaged 46 percent for low back pain, 32 percent for leg pain and 22 percent in leg numbness.

After the two-week regimen, no additional interventions were required in 50 percent of the seratonin-inhibitor group. But only 15 percent of the NSAID group required no additional interventions. Nerve root block was performed in 35 percent of the 5-HT2A receptor inhibitor group and in 45 percent of the NSAID group. There was a 20 percent rate of surgical intervention in the 5-HT2A receptor inhibitor group and 30 percent in the NSAID group.

Based on the results of this study, sertonin 5-HT2A receptor inhibitor is just as effective as NSAIDs in treating lumbar disc herniation.

Researchers included: Masahiro Kanayama, MD; Tomoyuki Hashimoto, MD; and Keiichi Shigenobu, MD, all of Hakodate, Japan.

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