Neuropathic Pain – New Treatment Hope?

nerve cellsResearchers at Duke University in the United States have made a potentially very important discovery in the fight against neuropathic pain.

In mice with neuropathic pain they injected bone marrow cells into the spinal cord area and found a significant reduction in their chronic pain for a relatively long period.

Treatment of pain from neuropathy is limited and has not greatly changed for many years, with improvement from medication measured in hours rather than longer periods.

The bottom line is that if a person has a chronic, neuropathic type pain, treatment options are limited. They have to suffer an unpleasant pain problem with poor relief and little change in their symptoms.

A neurologist may confirm they have a peripheral neuropathy and prescribe medication or a TENS machine but they are unable to get at the cause of the problem. Pain management may be a useful way to manage chronic pain but does not greatly change the pain problem itself.

Neuropathic pain is not well recognised or understood by the general public. However, anyone who has neuropathic pain knows very vividly what it’s all about. It can be severe, persistent and resistant to treatment, cutting badly into a person’s quality of life.

What Is Neuropathic Pain? A Quick Definition

The nervous system normally works as a transmitter of impulses generated in the tissues. In an ankle sprain for example, ligament tissues are damaged and the local nerves transmit pain up the nervous system to the brain where we can interpret what ‘s happened and take action as necessary.

In neuropathic pain, due to damage, disease or injury the nervous system becomes a generator of pain itself. Changes occur in the structure and in the electrical and chemical behaviour of nerves. This occurs in nerves in the body, the nerve bundles near the spinal cord, in the spinal cord and in the brain itself.

This means that treatment for a nerve pain in the ankle, back, neck or face will have a very limited effect as the problem is in the way the wiring is working. The nervous system lines have been rewired, a problem that drug treatment cannot reach.

Neuropathic pain conditions include trigeminal neuralgia, complex regional pain syndrome, peripheral neuropathy and diabetic neuropathy amongst others. Phantom pain after amputation could also be included in this category.

The Recent Research in Nerve Pain

Researchers damaged the lower limb nerves of mice by tying ligatures around them or by cutting short pieces of the nerves out so they could not transmit any more. These techniques are known to cause the central nervous system to set up a severe pain reaction.

They then removed a particular type of bone marrow cells from the mice, cells with the ability to develop into a variety of different cells. These cells are also able to suppress immune reactions in the nervous system.

Bone marrow cells were injected into the spinal canal via lumbar puncture (on a mouse!). The results showed several weeks of suppression of neuropathic pain from both types of deliberate nerve injury. A chemical (transforming growth factor beta one or TGF-β1) was shown to be a powerful changer of the pain transmitting mechanisms.

The pain relief started quickly, at around a day from the injection, and lasted for five weeks. Even if the pain was allowed to develop for 14 days before treatment, there was still a reduction in pain. The more cells that were injected the longer the period of pain relief.

This research is very important, although I don’t pretend to understand the complex anatomy and biochemistry laid out in the paper. For the first time it is possible to greatly reduce neuropathic pain for a significant length of time. This holds out hope that we will be able to find effective treatments for a large number of people who must live every day with pain.

Intrathecal bone marrow stromal cells inhibit neuropathic pain via TGF-β secretion
G Chen, CK Park, RG Xie, RR Ji – The Journal of clinical investigation, 2015
Image credit: On Flickr Album of neurollero

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