Procedure May Hold Promise For Neuropathic Pain

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Wrist pain was reported in about 9% of the cohort.
Wrist pain was reported in about 9% of the cohort.

NATIONAL HARBOR — An novel procedure – whereby patients are injected with the dermal filler cross-linked hyaluronic acid – may hold promise for ameliorating neuropathic pain.

Interviewed at the American Academy of Pain Medicine Meeting being held in National Harbor Maryland this weekend, John A. Campa, III, MD of Albuquerque, New Mexico told Clinical Pain Advisor he decided to try the procedure as a result of his training as a neurologist, pain specialist, and as someone who was trained in the use of dermal fillers

He said he tried the procedure on one of his regular patients, and conducted a 34-month chart review to help him identify 15 additional patients with persistent neuropathic pain.

After initially receiving a local anesthetic to determine the most reactive neural point (ie, innervating sensory nerve), and after the anesthetic block subsided (about four to seven days later) he injected a low dose – about .07 cc, of the CL-HA into the patient's pain point. Common areas of pain included in the face, spine, wrist, shoulder, and other areas. He noted his use of the CL-HA was off label since it is only approved as a cosmetic agent.

“All patients injected achieved pain relief, with the average post-procedure VAS pain score being 1.5 out of 10,” Campa wrote in his poster, which was presented during a late breaker session at the meeting. He added that most patients achieved this result immediately, and “average duration of pain relief was 7.7 months, and ranged from 2.5-18+months. There were no untoward reactions or effects.”

Campa said in the interview, "regarding the mechanism of how the procedure results in pain relief, I would welcome additional research to clarify this." However, he has developed three postulates. The first postulate is that CL_HA has a “physical, protecting shielding and compartment.” The second idea centers around depolarization; “polyanionic nature results in a sustained action potential refractory state.” The third postulate was that CL-HA acts as an inflammatory modulator.  

Reference

  1. Campa JA. LB01. “Cross-linked hyaluronic acid- a paradishm shift in the treatment of neuropathic pain.” Presented at: AAPM 2015. March 19-22, 2015; National Harbor, Maryland.
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