About the Institute

Disc related pain and associated neurological disability (radiculopathy, including sciatica and cervical radiculopathy) joins a long list of conditions, including rheumatoid arthritis, Crohn’s Disease, psoriasis, and Alzheimer’s Disease, which affect tens of millions of people across the globe, in which there is evidence that inflammation is initiated, maintained, or amplified by the inflammatory cytokine TNF-alpha (TNF). The INR is the world leader in the development and implementation of new methods of anti-TNF treatment for patients with a variety of conditions involving neurological inflammation.

The INR has active and on-going anti-TNF treatment programs for selected patients with disc-related back pain, neck pain, sciatica and related disorders in which excess TNF-alpha has been implicated as a causative factor.

INR medical providers evaluate patients with severe back pain, neck pain, or sciatica who have failed to adequately respond to medical treatment. The INR does not practice “pain management” and does not prescribe controlled substances. Rather, the INR has invented and offers a revolutionary new approach for reducing neuroinflammation. Scientific support for the INR’s anti-TNF breakthrough treatment methods (see U.S. patent 6,419,944) by independent academic centers around the world continues to be published. For example, please see:

Non-surgical, anti-TNF treatment at the INR for disc-related pain:

  • Low Back Pain
  • Neck Pain
  • Sciatica

The INR welcomes telephone inquiries from physicians, patients, or family members with questions regarding its treatment programs or research. Please call the INR at +1 (561) 353-9707 for further information.

For further background, please see the following scientific publications:

Appointments at the INR

Consultation and treatment are by appointment only.  Phone consultations can be scheduled by calling the INR PLLC in Boca Raton, Florida, at +1 (561) 353-9707, Monday through Thursday, 9 AM to 5:30 PM, and Friday, 9 AM to 5 PM Eastern Time.

Referrals to the INR

The INR welcomes referrals from neurologists, geriatricians, internists, family physicians, other health care providers, or family members of patients with conditions associated with neurologic inflammation, such as stroke, traumatic brain injury, Alzheimer’s disease, or intractable sciatica.  Individual treatment recommendations are only made following a consultation, including history, physical examination, and review of imaging studies.

The INR welcomes telephone inquiries from physicians and family members. In particular, the INR encourages telephone inquiry and discussion with an INR medical provider for those patients referred from locations at a geographic distance from Boca Raton, Florida, prior to appointment scheduling. This is recommended especially for those patients who will be flying across country or from overseas for treatment at the INR, due to the special nature of the services provided at the INR, and the unique experience which the INR has performing anti-TNF treatment for neurological disorders.

Selected INR Scientific Publications

1. Edward Tobinick M.D., Rapid improvement of chronic stroke deficits after perispinal etanercept: three consecutive cases. CNS Drugs, 2011. 25(2): p. 145-155.

2. Edward Tobinick M.D.., Perispinal etanercept: a new therapeutic paradigm in neurology. Expert Review of Neurotherapeutics, 2010. 10(6): p. 985-1002.

3. Tobinick, E.L., K. Chen, and X. Chen, Rapid intracerebroventricular delivery of Cu-DOTA-etanercept after peripheral administration demonstrated by PET imaging. BMC Res Notes, 2009. 2: p. 28.

4. Edward Tobinick M.D., The value of drug repositioning in the current pharmaceutical market. Drug News Perspect, 2009.22(2): p. 119-25.

5. Edward Tobinick M.D.., Perispinal etanercept for neuroinflammatory disorders. Drug Discov Today, 2009. 14(3-4): p. 168-77.

6. Edward Tobinick M.D.., Tumour necrosis factor modulation for treatment of Alzheimer’s disease: rationale and current evidence.CNS Drugs, 2009. 23(9): p. 713-25.

7. Tobinick, E.L. and H. Gross, Rapid cognitive improvement in Alzheimer’s disease following perispinal etanercept administration. J Neuroinflammation, 2008. 5: p. 2.

8. Tobinick, E.L. and H. Gross, Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer’s disease. BMC Neurol, 2008. 8: p. 27.

9. Edward Tobinick M.D., Perispinal etanercept produces rapid improvement in primary progressive aphasia: identification of a novel, rapidly reversible TNF-mediated pathophysiologic mechanism. Medscape J Med, 2008. 10(6): p. 135.

10. Edward Tobinick M.D., Perispinal etanercept for treatment of Alzheimer’s disease. Curr Alzheimer Res, 2007. 4(5): p. 550-2.

11.  Edward Tobinick M.D. , The cerebrospinal venous system: anatomy, physiology, and clinical implications. MedGenMed, 2006.8(1): p. 53.

12. Edward Tobinick M.D., et al., TNF-alpha modulation for treatment of Alzheimer’s disease: a 6-month pilot study. MedGenMed, 2006. 8(2): p. 25.

13. Edward Tobinick M.D., Spinal delivery of p38: TNF-alpha inhibitors. PLoS Med, 2006. 3(11): p. e511.

14. Tobinick, E. and S. Davoodifar, Efficacy of etanercept delivered by perispinal administration for chronic back and/or neck disc-related pain: a study of clinical observations in 143 patients. Curr Med Res Opin, 2004. 20(7): p. 1075-85.

15. Tobinick, E.L. and S. Britschgi-Davoodifar, Perispinal TNF-alpha inhibition for discogenic pain. Swiss Med Wkly, 2003.133(11-12): p. 170-7.

16. Edward Tobinick M.D., Targeted etanercept for treatment-refractory pain due to bone metastasis: two case reports. Clin Ther, 2003. 25(8): p. 2279-88.

INR Scientific Background

The INR’s scientific findings have been published in multiple, peer-reviewed medical journals, including Expert Review of Neurotherapeutics, CNS Drugs, BMC Neurology, Current Alzheimer Research, Clinical Therapeutics, Drug Discovery Today, and Current Medical Research and Opinion. INR publications, findings, and research have advanced the science of neurology, dementia, and spine medicine, and have been cited and discussed by physicians and scientists from academic centers around the world. There have been more than 500 scientific citations to INR publications, including in Nature Clinical Practice Neurology and F1000 Biology.

Edward Tobinick, MD, Founder of the INR, has presented his scientific findings regarding the effects of etanercept for neurological disorders at multiple U.S. and international medical and scientific conferences, including the Karolinska Institute in Sweden; the 2008 Drug Repositioning Summit in Boston; the International Conference on Alzheimer’s Diseasein Chicago; the 7th Annual Alzheimer’s Drug Discovery Conference in New York; the 2008 Best Practices in the Continuum of Care: Advances in Alzheimer’s Disease Management conference at the University of Arkansas Medical Sciences in Little Rock, Arkansas; and, in 2009, the 3rd International Restauracion Neurologica Conference in Havana, Cuba, the World Pharmaceutical Congress in Philadelphia and the 5th Modern Drug Discovery Conference in San Diego. Dr. Tobinick has performed collaborative research with scientists from Stanford University School of Medicine and additional academic centers. Download a copy of Dr Tobinick’s Curriculum Vitae PDF Here.

Relevant Scientific Publications

1.  Sommer C, Schafers M, Marziniak M, Toyka KV. Etanercept reduces hyperalgesia in experimental painful neuropathy. J Peripher Nerv Syst. 2001;6(2):67-72.

2. Sommer C, Lindenlaub T, Teuteberg P, Schafers M, Hartung T, Toyka KV. Anti-TNF-neutralizing antibodies reduce pain-related behavior in two different mouse models of painful mononeuropathy. Brain research. 2001;913(1):86-9.

3. Covey WC, Ignatowski TA, Renauld AE, Knight PR, Nader ND, Spengler RN. Expression of neuron-associated tumor necrosis factor alpha in the brain is increased during persistent pain. Reg Anesth Pain Med. 2002;27(4):357-66.

4.  Reynolds JL, Ignatowski TA, Spengler RN. Effect of tumor necrosis factor-alpha on the reciprocal G-protein-induced regulation of norepinephrine release by the alpha2-adrenergic receptor. J Neurosci Res. 2005;79(6):779-87.

5. Cohen SP, Bogduk N, Dragovich A, Buckenmaier CC, 3rd, Griffith S, Kurihara C, et al. Randomized, double-blind, placebo-controlled, dose-response, and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica. Anesthesiology. 2009;110(5):1116-26.

6. Ohtori S, Miyagi M, Eguchi Y, Inoue G, Orita S, Ochiai N, et al. Epidural administration of spinal nerves with the tumor necrosis factor-alpha inhibitor, etanercept, compared with dexamethasone for treatment of sciatica in patients with lumbar spinal stenosis: a prospective randomized study. Spine. 2012;37(6):439-44.

7. Freeman BJ, Ludbrook GL, Hall S, Cousins M, Mitchell B, Jaros M, et al. Randomized, Double-blind, Placebo-Controlled, Trial of Transforaminal Epidural Etanercept for the Treatment of Symptomatic Lumbar Disc Herniation. Spine. 2013;38(23):1986-94.

8. Kaufman EL, Carl A. Biochemistry of Back Pain. The Open Spine Journal. 2013;5:12-8.

9. Sainoh T, Orita S, Yamauchi K, Suzuki M, Sakuma Y, Kubota G, et al. Intradiscal Administration of Tumor Necrosis Factor-Alpha Inhibitor, Etanercept, Clinically Improves Intractable Discogenic Low Back Pain: A Prospective Randomized Study.  International Society for the Study of the Lumbar Spine 40th Annual Meeting; Scottsdale, Arizona2013.

10. Winkelstein BA, Allen KD, Setton LA. Chapter 19: Intervertebral Disc Herniation: Pathophysiology and Emerging Therapies. In: Shapiro IM, Risbud MV, editors. The Intervertebral Disc. Wien, Austria: Springer-Verlag; 2014.

12. Zanella JM, Burright EN, Hildebrand K, Hobot C, Cox M, Christoferson L, et al. Effect of etanercept, a tumor necrosis factor-alpha inhibitor, on neuropathic pain in the rat chronic constriction injury model. Spine. 2008;33(3):227-34.

13. Watanabe K, Yabuki S, Sekiguchi M, Kikuchi S, Konno S. Etanercept attenuates pain-related behavior following compression of the dorsal root ganglion in the rat. Eur Spine J. 2011;20(11):1877-84.

14. Martuscello RT, Spengler RN, Bonoiu AC, Davidson BA, Helinski J, Ding H, et al. Increasing TNF levels solely in the rat hippocampus produces persistent pain-like symptoms. Pain. 2012;153(9):1871-82.

15. Ignatowski TA, Gerard BA, Bonoiu AC, Mahajan S, Knight PR, Davidson BA, et al., editors. Reduction of tumor necrosis factor (TNF) in the hippocampus alleviates neuropathic pain perception. . Proceedings of the 4th International Congress on Neuropathic Pain Pp 29-35; 2013.

16. Coelho SC, Bastos-Pereira AL, Fraga D, Chichorro JG, Zampronio AR. Etanercept reduces thermal and mechanical orofacial hyperalgesia following inflammation and neuropathic injury. European journal of pain. 2014.