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4242
Platelet-rich plasma in treating peripheral neuropathic pain. Preliminary report
Session: MP-03a
Thurs, Nov. 16, 1:30-3:30 pm
Hampton Room

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Platelet-rich plasma in treating peripheral neuropathic pain.

Preliminary report

 

ID: 4242

Author:  José Correa, MD

Anesthesia - Pain Unit, Fundación Universitaria JN Corpas,  Bogotá - Colombia

Email: [email protected]

 

Introduction

Background: Neuropathic pain (NP) is a chronic form of progressively incapacitating pain with a high impact on patients' quality of life. Often underdiagnosed and undertreated, NP has currently no effective treatment schemes, despite the many drugs and many techniques that have been proposed. Recently, biological therapy using PRP has been attracting more attention in the field of NP management. Evidence is accumulating in both preclinical and clinical settings indicating that PRP and fibrin scaffolds hold an important adjuvant therapeutic potential in repairing injured peripheral nerves and relieving NP. 

Objectives: This paper examines the effects of platelet-rich plasma (PRP) on relieving such form of pain applying it to the site where NP originates.

Materials and methods

Study Design: Prospective observational study carried out between June 2015 and December 2016, in which forty-five patients referred to the Pain Unit with the diagnosis of peripheral NP and refractory multimodal-approach to pharmacologic management for more than 3 months were included in the study. Institutional approval and informed consent were signed by all patients.

Method: All patients received a sonographic-guided injection of PRP at the affected dermatome site. Outcome assessed the reduction in pain intensity measured by the visual analogue scale (VAS) which provide data only on pain intensity, and the revised "short-form McGill Pain Questionnaire-2" (SF-MPQ-2), which permits the quality assessment of pain, desirable for this type of research. Daily dosage requirements of the commonly neuropathic-pain medication taken by the patient were also assessed.

 

 

Results

At the end of three month follow-up, the pain score was reduced up to 70% in 39 out of the 45 patients, permitting the lowering of pain medication and improving their quality of life.

Discussion

All neuropathic pain disorders have a common denominator, which is the damage of the somatosensory nervous system: nerve lesions leads to dramatic changes in the nervous system. However, the underlying etiologies and pathogeneses of these damages are distinct and not one but several mechanisms can lead to NP.

Currently, there are no drugs that can treat NP in a complete and definitive way. The effectiveness of treatment for patients with NP should consider, therefore, a better understanding of its pathophysiological mechanisms. Research on the pathophysiologic mechanisms of NP predicts the near future application of a more effective and specific mechanismbased treatment approach, not just palliative medicine. The trend with cell-based therapies clearly appears to be rising up in the field of pain units, and this entirely different strategy in which pain is differentiated on the basis of the underlying mechanisms is the novel proposal.

Conclusion

The positive and promising results with PRP in treating peripheral NP in the present study encourage us for further clinical investigations.

Limitations: Similar to other reports in which this novel cell-based therapy with PRP has been used in the management of NP, this study is just a small case series. Critical to exploring the role of PRP in treating neuropathic pain and to assessing whether PRP is effective, further clinical studies should be performed in the future, in randomized controlled trials.

Conflicts of Interest: None declared.

References

1. Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, Kalso EA, Loeser JD, Miaskowski C, Nurmikko TJ, Portenoy RK, Rice A, Stacey BR, Treede RD, Turk DC, Wallace MS. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pharmacologic management of neuropathic pain: Evidence-based recommendations. PAIN. 2007; 132 (3): 237–251.

2. Luis Garcia-Larrea. The Pathophysiology of Neuropathic Pain: Critical Review of Models and Mechanisms. Pain 2014: Refresher Courses, 15th World Congress on Pain.

3. O'Connor AB, Dworkin RH. Treatment of Neuropathic Pain: An Overview of Recent Guidelines. The American Journal of Medicine. 2009; 122(10): S22-S32.

4. Kuffler DP. Platelet-rich plasma and the elimination of neuropathic pain. Mol Neurobiol. 2013; 48(2):315-332.

5. Sánchez M, Garate A, Delgado D, Padilla S. Platelet-rich plasma, an adjuvant biological therapy to assist peripheral nerve repair. Neural Regen Res. 2017 Jan; 12(1): 47–52.

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