Neuropathic Pain

Perineural Injection of Platelet-Rich Plasma for Peripheral Neuropathy Pain

Amit Akirov, MD
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There are 4 main types of diabetic neuropathy: peripheral, autonomic, radiculoplexus, and mononeuropathy. Diabetic peripheral neuropathy is the most common, and is associated with tingling and burning sensations in the extremities. Autonomic neuropathy can disrupt the function of other organs, leading to bladder problems, constipation, sexual dysfunction, and the loss of the ability to regulate body temperature, blood pressure, and heart rate. Mononeuropathy is often the cause behind facial paralysis and problems with eyesight, though these symptoms tend to not be long-term.
There are 4 main types of diabetic neuropathy: peripheral, autonomic, radiculoplexus, and mononeuropathy. Diabetic peripheral neuropathy is the most common, and is associated with tingling and burning sensations in the extremities. Autonomic neuropathy can disrupt the function of other organs, leading to bladder problems, constipation, sexual dysfunction, and the loss of the ability to regulate body temperature, blood pressure, and heart rate. Mononeuropathy is often the cause behind facial paralysis and problems with eyesight, though these symptoms tend to not be long-term.
Perineural injection of platelet-rich plasma may improve pain and numbness associated with diabetic peripheral neuropathy, and enhance peripheral nerve function.

Perineural injection of platelet-rich plasma (PRP) may improve pain and numbness associated with diabetic peripheral neuropathy (DPN), and enhance peripheral nerve function, according to study results published in Pain Medicine.

PRP injection was found to enhance local healing, tissue remodeling, and nerve axonal regeneration, and to improve recovery of nerve function in patients with neuropathic pain.

In this prospective randomized outcome-assessor blinded study, 60 patients with type 2 diabetes mellitus and symptomatic DPN (painful neuropathy for ≥6 months) who were treated in the pain clinic of the Anesthesia Department and the electro-diagnosis unit of the Rheumatology and Rehabilitation Department at Assiut University Hospital, Egypt, were enrolled. Participants were randomly assigned to receive an ultrasound-guided PRP injection performed in the pain clinic, in addition to medical treatment or medical treatment only. The study’s primary outcome was the quality of pain alleviation during the 6-month follow-up period after perineural PRP injection. Improvement of numbness, nerve conduction studies, and modified Toronto Clinical Neuropathy Score (mTCNS) were secondary end points. Pain and numbness, evaluated using visual analog scale, and mTCNS scores were assessed at baseline and 1, 3, and 6 months after treatment. mTCNS scores were considered a reliable and sensitive score for the diagnosis and assessment of DPN progress.

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Patients who received medical treatment plus PRP injection vs treatment alone reported improvements in pain and numbness (P ≤.001 for both during the whole study period) and in mTCNS scores at months 1 (P =.01), 3 (P =.001), and 6 (P <.001).

Study limitations include the lack of glucose control monitoring during follow-up, the heterogeneity of neuropathy pattern in the cohort, and inherent limitations of electrodiagnostic studies that only assess large myelinated nerve fibers.

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“Perineural PRP injection is an effective therapy for alleviation of diabetic neuropathy pain and numbness and enhancement of peripheral nerve function,” concluded the authors.

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Reference

Hassanien M, Elawamy A, Kamel EZ, et al. Perineural platelet-rich plasma for diabetic neuropathic pain, could it make a difference? [published online July 12, 2019]. Pain Med. doi:10.1093/pm/pnz140

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