Platelet-rich plasma in treating peripheral neuropathic pain.
Author: José Correa, MD
Anesthesia - Pain Unit, Fundación Universitaria JN Corpas, Bogotá - Colombia
Email: [email protected]
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.
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.
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.
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.
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