Discussions that mention enbrel

Back Problems board


My insurance company will not cover ENBREL to see if it will help with my disc pain. Unfortunately, the drug comes in a box of 4 vials and I only need 1 vial to determine if the drug will help me. The entire box costs over $600. I want to pay full price for 1 vial, but am unable to find a pharmacy, hospital, or nursing home that will break up a 4-pack. Can anybody help??

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1. Lower back pain started 9/2002. No traumatic injury. Avid recreational tennis player (4-5X/week) and downhill skier. Also enjoyed biking and hiking.
2. First 3 months after initial pain did NOT listen to my body and continued to activities that worsened pain.
3. 1/2003 MRI shows disc protrusion/herniation at L5/S1 (midline). Also shows degenerative endplate changes, loss of disc signal intensity (DDD).
4. 2/2003 Caudal epidural injection fails. Multiple anti-inflammatories fail. 5. 2/2003-5/2003 2x week PT. Stopped sitting for work. After several months, PT agrees that treatment is making me worse. Any extension exercise (e.g. Mackenzie)makes symptoms much worse.
6. 4 Orthopedic and neurosurgeons say fusion or ADR my only hope.
7. 6/2003 Started taking Neurontin 900mg tid. Did not think drug was helping until I stopped taking it and pain went through the roof. Does seem to reduce pain by 2 points.
8. 6/2003 Visit with Dr. Jeffrey Saal to discuss IDET. Dr. Saal says my disc is on its “last hurrah.” Has been degenerating for many years, but my body has adapted. Thinks that I will be pain free once last bit of hydrated portion of disc (nucleus) has leaked out. Refers me for bi-lateral selective epidural injections.
9. 8/2003 Pain clinic performs interlaminar epidural--no relief; 9/2003 Pain clinic performs selective (transforaminal) injections—no relief.
10. Discogram on 10/13. Results show condordant pain at L5-S1 at low pressure, Grade V annular tear, 50% loss of disc height. No leakage aside from annular tear.
11. Based on estimate from IDET expert of 50-50 chance (conservative guess)of good outcome, will schedule procedure.
Hey tennisnut :wave:
I'm planning on asking my doctor about Enbrel when I see him next (Nov 13). It sounds very interesting...

Maybe we could split a box? I live pretty close to you.

What do you think?
[img]http://www.healthboards.com/ubb/heart.gif[/img] Telzey

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4 years of back pain, but was still able to work and maintain moderate activity (hiking, low-impact aerobic exercise)
Annular tear L5-S1 diagnosed 5/02 via MRI
IDET 12/2/02
1/26/03 Posterior disc prolapse occurs after sitting too long after walking. Causes new pain down left leg.
3/1/03 Leg pain reduced with exercises from the book "Treat Your Own Back" by Robin McKenzie.
3/9/03 Severe, new buttock and thigh pain and numbness starts.
3/25/03 Used McKenzie techniques to treat buttock and thigh pain -- pain reduced
4/4/03 Started physical therapy
5/8/03 Still worse than pre-IDET, but showing slow improvement with PT, McKenzie exercises, yoga, and Hanna Somatics exercises
5/30/03 PT suggests buttock and thigh pain may be from facet joint
7/6/03 Still worse than pre-IDET due to leg and thigh pain and numbness, and have become so inactive I can't tell whether back pain is better. Can't stand for any length of time, can't walk long, run at all, or do any aerobic activity. I regret agreeing to the IDET and wish I had had more patience with the natural healing process of my disc!
Your observations are correct. Enbrel is typically used by people with Rheumatoid Arthritis who need to receive shots twice a week. For these people, having to purchase Enbrel in a 4-pack or 8-pack is perfectly appropriate. Unfortunately, since using it for LBP is considered off-label, insurance companies will most likely refuse to pay. Go ahead and buy the 4-pack and keep the spare 3 in your refridgerator just in case. You may need a second shot. It will last 6 months if kept at the proper temperature.

You are lucky. TheJude5 had to buy an 8-pack for $1300 and has only used one vial. Yesterday was her 3 week anniversary and she is still pain-free! She has been able to go to P/T this week (twice!) for the first time in nearly a year. The $1300 she had to pay seems a tiny price to pay to get her life back.

We expect her to need probably one more shot, what to do with the other 6? We don't know. This is uncharted territory. However, just the savings in co-pays for pain medication alone might make it a worthwhile investment.

Know this: 5 years from now this will be standard treatment for people with no sensory (tingling or numbness) or motor (weakness) symptoms. 5 years from now doctors and pain clinics will keep their own supply and only charge you for the vials you use. Unfortunately, it is today. However if your only symptom is pain, the $600 may be worth it even if you end up throwing away the other 3 vials.

[This message has been edited by mlbphd (edited 10-31-2003).]
Tennisnut--I am curious what the screening process was for your doc to approve the Enbrel. Was this Dr. Saal, may I ask?

Thanks,

Standingman
Standingman: I haven't conferred with Dr. Saal about Enbrel as I see him more irregularly than the pain mgmt doctor who is on my health plan. That doctor (Dr. Krames) wasn't that familiar with Enbrel. When I gave him the article of cases studies, he said that he would study it and do a risk profile for the drug. From everything I have read, the drug can be risky for people who either have a current infection or tend to get infections because the drug lowers your immune response. Since I do not fall into these categories, I am not concerned about a potentially serious adverse event. But all drugs have side effects. I will tell you more in my next post, which will be after I have met with Dr. Krames to discuss the risk profile and (presumably) have had the injection.

--tennisnut
Hi everyone,

I had my shot of Enbrel on Wednesday and am sad to report that I had no benefit from the medication. Not even a measly, short-lived placebo effect. So I plan to go ahead with the IDET procedure scheduled for 11/17. I feel better having exhausted all options, even to the tune of over $600.

Sorry that I have no miracle to report back. It may very well be that the pain generators in my disc stem more from the nerves growing in the outer annulus than to the disc material itself. If so, the the IDET should theorectically help by killing the nerves.

Telzey--let me know if you want to buy a shot of Enbrel from me. You don't have to split the box-I'll sell you just what one shot would cost ($625/4).
The next e-mails you'll be getting from me will very likely be post-IDET. Will keep everyone updated on my recovery.

--tennisnut