Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine whether or not Enbrel (etanercept) is safe and effective in treating patients with sciatic nerve pain resulting from lumbar disc herniation or spinal stenosis.

STUDY DESIGN: Review of three English language primary randomized controlled trials from 2012- 2013.

DATA SOURCES: One triple-blind, placebo-controlled randomized clinical trial, one double-blind, placebo-controlled randomized clinical trial, and one prospective randomized clinical trial were found using PubMed. These studies compared treatment with etanercept to treatment with saline and steroids (dexamethasone or methylprednisolone).

OUTCOMES MEASURED: Clinical outcomes of leg and back pain were measured using numeric pain rating scales, global perceived effect (GPE) surveys, and the oswestry disability index (ODI).

RESULTS: One triple-blind and one double-blind placebo controlled trial were reviewed, in addition to one prospective randomized trial. Cohen et al did not find any statistically significant differences in pain relief between the etanercept and saline groups, and subjects in the etanercept group did not experience any improvement in disability. Freeman et al found clinically and statistically significant improvements in leg and back pain as well as improvements in disability in the etanercept group when compared to placebo. Ohtori et al found that etanercept provided better pain relief and improvement in disability than dexamethasone. However, this difference was not statistically significant.

CONCLUSIONS: Based on the studies reviewed in this paper, the evidence is conflicting in determining whether or not etanercept is safe and effective in treating radiculopathy and sciatica resulting from lumbar herniation and spinal stenosis.