Pentoxifylline Reduced Radiculopathy Associated With Degenerative Disc

Herniated-Disc
Pentoxifylline decreased pain in the setting of lower back pain with radiculopathy due to lumbar disc herniation.

A pilot study found evidence to suggest that pentoxifylline (PTX), when added to usual care, may safely reduce short-term radicular pain among patients with degenerative disc disease. These findings were published in Clinical Neurology and Neurosurgery.

Patients (N=58) with lumbar disc herniation were recruited for this prospective, randomized, single-blind crossover clinical trial at Hotel-Dieu de France University Hospital in Beirut between 2018 and 2021.

Enrolled patients received 600 mg ibuprofen twice daily, 1000 mg paracetamol 3 times a day, and 75 mg pregabalin twice daily for 30 days as standard therapy regimen. Patients were randomized to receive an additional 400 mg PTX twice daily for 15 days followed by 15 days of no additional treatment (n=30) or no additional treatment followed by PTX (n=28). Patients underwent magnetic resonance imaging (MRI) to evaluate the extent of disease and reported pain symptoms using the numeric rating scale (NRS).

Patients were aged mean 56.63±11.45 years, 53.4% were men, they had symptoms for 3.57±1.77 months, and average baseline NRS pain score was 7.62±1.04.

During the 15-day PTX treatment, the average NRS pain score was 3.2±0.84 compared with 5.1±0.97 during the 15 days without PTX (P <0.0000). During the first 15-day period, the PTX recipients reported lower NRS pain scores (mean, 3.18 vs 4.92; P <0.0000).

This was similar to the second 15-day period (mean, 2.63 vs 4.67; P <.0.0000).

Patient Global Impression of Change (PGIC) scores were higher during the PTX treatment period than during no treatment, in which most had a score of 7 (n=19) during additional treatment and a score of 4 (n=18) during no PTX (P <0.0000).

NRS score on the last day of PTX treatment was associated with herniated lumbar disc volume at MRI (P =.04) and NRS at baseline (P =.05).

Two patients reported PTX-related side effects of nausea (n=1) and dizziness (n=1).

The major limitation of this study was the lack of a placebo pill, not allowing for double-blinding.

In conclusion, this pilot study found that 800 mg daily PTX in supplement to ibuprofen and paracetamol may substantially reduce pain symptoms among patients with lumbar disc herniation associated with degenerative disc disease. These findings should be confirmed in a larger, double-blind, randomized, prospective trial.

Reference

Tarabay B, Komboz F, Kobaïter-Maarrawi S, Fayad F, Zeid HA, Maarrawi J. Pentoxifylline significantly reduces radicular pain secondary to lumbar disc hernia: A prospective, randomized crossover, single-blind controlled pilot study. Clin Neruo Neursurgery. 2022;107309. doi:10.1016/j.clineuro.2022.107309