Frequently Asked Questions

When did the INR invent its anti-TNF pain treatment?

The INR invented and pioneered local anti-TNF treatment for chronic spinal pain (low back pain, neck pain, or sciatica) in 1999 and is established as the world leader in anti-TNF treatment for pain. The INR has more than a decade of favorable clinical experience in this area, and has treated more than 3,000 patients from all over the world.

Where can I receive this treatment?

The INR anti-TNF treatment is a patented treatment method available exclusively through medical providers trained at the INR.  The INR is located in Boca Raton, Florida.  Contact info

Why is this a patented treatment?

Novel methods of administration of patented drugs are patentable. The Founder of the INR, Edward Tobinick, MD, invented novel methods of administration of anti-TNF molecules for the treatment of neurological disorders more than a decade ago. These methods have demonstrated clinical utility for the treatment of a variety of neurological disorders, including not only spinal pain (low back pain, neck pain, and sciatica) but also other neurological disorders, such as Alzheimer’ disease, brain injury, and chronic stroke, that are associated with excess TNF[1-12].


Does the INR practice pain management?

No, INR medical providers do not prescribe opioid medications. The INR medical providers evaluate each patient individually and give individual recommendations for treatment. Not every patient is a candidate for the INR anti-TNF treatment program. For example, patients with active serious infection cannot be treated with anti-TNF therapeutics until their infection has resolved and patients with multiple sclerosis are also not candidates for treatment. An individual phone or in-office consultation with an INR medical provider is necessary for definite determination of potential candidacy for INR anti-TNF treatment.

If I have had pain for more than two years does this mean I am not a candidate for INR anti-TNF treatment?

No. There is no time limitation for the length of symptoms. Many patients treated successfully at the INR have had pain for more than ten years; some of had pain for more than 40 years and some have only had pain for weeks.

If I have had spinal surgery but I still have pain am I still a candidate?

Candidacy for treatment is determined on an individual basis. The INR medical providers have treated many patients who had chronic pain despite spinal surgery. Individual results vary. Please see the Terms of Use for further information.


  1. Perispinal etanercept: a new therapeutic paradigm in neurology. Edward Tobinick MD. Expert Review of Neurotherapeutics. 2010 Jun;10(6):985-1002.
  2. Perispinal etanercept for neuroinflammatory disorders. Edward Tobinick MD. Drug Discovery Today. 2009 Feb;14(3-4):168-77.
  3. Efficacy of etanercept delivered by perispinal administration for chronic back and/or neck disc-related pain: a study of clinical observations in 143 patients. Edward Tobinick MD, Susan Davoodifar MD. Curr Med Res Opin. 2004 Jul;20(7):1075-85.
  4. Perispinal TNF-alpha inhibition for discogenic pain.  Edward L. Tobinick MD, Susan Britschgi-Davoodifar. Swiss Med Wkly. 2003 Mar; 133(11-12):170–7.
  5. Randomized, double-blind, placebo-controlled, dose-response, and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica. Cohen SP, Bogduk N, Dragovich A, Buckenmaier CC 3rd, Griffith S, Kurihara C, Raymond J, Richter PJ, Williams N, Yaksh TL. Anesthesiology. 2009 May;110(5):1116-26.PMID:19387178.
  6. Tumor Necrosis Factor-Alpha Antagonist Reduces Apoptosis of Neurons and Oligodendroglia in Rat Spinal Cord Injury.Chen KB, Uchida K, Nakajima H, Yayama T, Hirai T, Watanabe S, Guerrero AR, Kobayashi S, Ma WY, Liu SY, Baba H. Spine (Phila Pa 1976). 2011 Jan 8. [Epub ahead of print] PMID: 21224756.
  7. Etanercept restores the antinociceptive effect of morphine and suppresses spinal neuroinflammation in morphine-tolerant rats. Shen CH, Tsai RY, Shih MS, Lin SL, Tai YH, Chien CC, Wong CS. Anesth Analg. 2011 Feb;112(2):454-9.PMID:21081778.
  8. Direct application of the tumor necrosis factor-alpha inhibitor, etanercept, into a punctured intervertebral disc decreases calcitonin gene-related peptide expression in rat dorsal root ganglion neurons. Horii M, Orita S, Nagata M, Takaso M, Yamauchi K, Yamashita M, Inoue G, Eguchi Y, Ochiai N, Kishida S, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Kuniyoshi K, Suzuki M, Nakamura J, Toyone T, Takahashi K, Ohtori S. Spine (Phila Pa 1976). 2011 Jan 15;36(2):E80-5. PMID: 21057386.