Kuffler Damien P, Reyes Onix, Sosa Ivan J, Micheo William F, Santiago-Figueroa Jose M, Foy Christian A
Institute of Neurobiology, Medical School, University of Puerto Rico, San Juan, PR, 00901, USA.
Doctor's Center Hospital, Manati, PR, 00674, USA.
J Pain Res. 2025 Jun 27;18:3207-3216. doi: 10.2147/JPR.S523451. eCollection 2025.
Peripheral nerve trauma is associated with 50-79% of individuals developing chronic neuropathic pain. No technique reliably induces long-term chronic neuropathic pain reduction/elimination.
This study compared the influence of bridging peripheral nerve gaps with an autograft vs an autograft within a platelet-rich plasma- (PRP) filled collagen tube (PRP repair) on the level of long-term chronic neuropathic pain.
Pre-surgery, all 11 autograft repair subjects suffered chronic neuropathic pain of 4-10 (mean 8.6±4.2), with 81.8% of 8-10. Following repairs, pain reduction started when axons started reinnervating targets. The pain decreased to 0-6 (mean 0.27 ± 0.3), with 18.2% having long-term pain reduction and 81.8% long-term pain elimination. Pre-surgery, of the 15 PRP repair subjects, 60% suffered chronic pain of 4-10 (mean 7.7 ± 1.4), with 66.7% pain of 8-10. Pain reduction began within two weeks, and within two months, 11% of the subjects had maximum pain reduction and 89% long-term pain elimination. The pain never increased or occurred over the following 1.1-15.4 years.
Chronic neuropathic pain is normally reduced/eliminated when axons reinnervate targets, including by using targeted muscle reinnervation (TMR). However, bridging nerve gaps with an autograft within a PRP-filled collagen tube reduces/eliminates pain far faster because axon regeneration and target reinnervation are not required, only that platelet-released factors act on the peripheral axons. In addition, the PRP technique induces pain reduction several times greater than TMR, and although TMR is only effective when applied less than four months post-trauma, PRP is effective when applied at least up to 3.25 years post-trauma. This is the first clinical demonstration that PRP induces long-term pain reduction/elimination by factors acting only on peripheral axons, while they are regenerating and does not require target reinnervation. This study sets the stage for testing whether bridging gaps with only a PRP-filled collagen tube has the same effects.
50% - 79%的外周神经损伤患者会发展为慢性神经性疼痛。目前尚无技术能可靠地实现长期慢性神经性疼痛的减轻或消除。
本研究比较了使用自体移植物桥接外周神经间隙与在富含血小板血浆（PRP）填充的胶原管内进行自体移植（PRP修复）对长期慢性神经性疼痛水平的影响。
术前，所有11名接受自体移植修复的受试者慢性神经性疼痛评分为4 - 10分（平均8.6±4.2），其中8 - 10分的占81.8%。修复后，当轴突开始重新支配靶组织时疼痛开始减轻。疼痛评分降至0 - 6分（平均0.27±0.3），18.2%的患者长期疼痛减轻，81.8%的患者长期疼痛消除。术前，15名接受PRP修复的受试者中，60%患有4 - 10分的慢性疼痛（平均7.7±1.4），其中66.7%的疼痛评分为8 - 10分。疼痛在两周内开始减轻，两个月内，11%的受试者疼痛最大程度减轻，89%的受试者长期疼痛消除。在接下来的1.1 - 15.4年中，疼痛从未加重或再次出现。
当轴突重新支配靶组织时，慢性神经性疼痛通常会减轻或消除，包括通过使用靶向肌肉神经再支配（TMR）。然而，在PRP填充的胶原管内使用自体移植物桥接神经间隙能更快地减轻或消除疼痛，因为不需要轴突再生和靶组织再支配，仅需血小板释放的因子作用于外周轴突。此外，PRP技术引起的疼痛减轻程度是TMR的数倍，虽然TMR仅在创伤后不到四个月应用时有效，但PRP在创伤后至少3.25年应用时仍有效。这是首次临床证明PRP通过仅在外周轴突再生时作用于它们的因子诱导长期疼痛减轻或消除，且不需要靶组织再支配。本研究为测试仅用PRP填充的胶原管桥接间隙是否有相同效果奠定了基础。
