New treatment of lumbar disc herniation involving 5-hydroxytryptamine2A receptor inhibitor: a randomized controlled trial.
OBJECTIVE
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-HT2A receptor inhibitor in the treatment of symptomatic lumbar disc herniation.


METHODS
Forty patients with sciatica due to L4-5 or L5-S1 disc herniation were randomly allocated to treatment with the 5-HT2A 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. The mean VAS score improvements in the 5-HT2A 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-HT2A-treated patients and 15% of those receiving NSAIDs. Epidural or nerve root block procedures were performed in 35% of the 5-HT2A group and 45% of the NSAID group. Surgery was required in 20% of the 5-HT2A group and 30% of the NSAID group patients.


CONCLUSIONS
The current study provided evidence that the efficacy of the 5-HT2A inhibitor was comparable with that of NSAID therapy for lumbar disc herniation. The 5-HT2A inhibitor has the potential to alleviate symptoms in patients with lumbar disc herniation.
Kanayama
Masahiro
M
Department of Orthopaedic Surgery, Hakodate Central General Hospital, Hakodate, Japan. mkanayama@aol.com
Hashimoto
Tomoyuki
T
Shigenobu
Keiichi
K
Oha
Fumihiro
F
Yamane
Shigeru
S
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000379:methods; D004008:Diclofenac / Q000627:therapeutic use; D004824:Epidural Space; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D017116:Low Back Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D012585:Sciatica / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D058830:Serotonin 5-HT2 Receptor Antagonists; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D013386:Succinates / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D058830:Serotonin 5-HT2 Receptor Antagonists; D012702:Serotonin Antagonists; D013386:Succinates; D004008:Diclofenac; C064294:sarpogrelate