Background & Aims
Traumatic peripheral neuropathy, due to cutting, stretching, commonly seen in young age group, can be painful and disabling leading to poor quality of life. Response to conventional therapy or to surgical nerve repair may be unsatisfactory due to inadequate pain control and poor functional recovery. The role of local administration of growth factor concentrate (GFC) injection for neuropathic pain management and functional recovery in traumatic peripheral neuropathy has been evaluated in this case.
Methods
13yrs old girl presented to pain OPD, with H/O, pain (NRS – 10/10), swelling, decreased sensations, tingling and inability to extend fingers and thumb of left hand following fall from motorbike 2 months ago. Nerve conduction study documented left ulnar and median motor neuropathy, mild axonal loss with partial conduction block. Patient had received analgesics over last 2 months with no pain relief or function recovery. She could not do physiotherapy due to severe pain. Motor power assessment could not be done as well. Patient received ultrasound (USG) guided analgesic block of ulnar and median nerve with 3ml of 0.125% bupivacaine with 1mg dexamethasone at both sites. Post block NRS – 1/10, power – 1/5. Patient also received 6 sessions of dry needling over 4 weeks along with Tab pregabalin 25mg at bed time, Tab paracetamol 250mg BID and Tab nortryptiline 10mg at bed time along with Vit D3 & Vit B12 supplements, with no much improvement in pain score or motor function recovery. A USG guided stellate ganglion block with 1% preservative free lignocaine was administered after a week with no effect on NRS. After a month, Growth Factor Concentrate (GFC) of 4 ml, was derived from patient’s own blood of 8ml, and was administered around affected nerves. Four weeks post GFC injection, patient had NRS of 2/10 at rest and on movement and motor power of 5/5.
Results
13yrs old girl presented to pain OPD, with H/O, pain (NRS – 10/10), swelling, decreased sensations, tingling and inability to extend fingers and thumb of left hand following fall from motorbike 2 months ago. Nerve conduction study documented left ulnar and median motor neuropathy, mild axonal loss with partial conduction block. Patient had received analgesics over last 2 months with no pain relief or function recovery. She could not do physiotherapy due to severe pain. Motor power assessment could not be done as well. Patient received ultrasound (USG) guided analgesic block of ulnar and median nerve with 3ml of 0.125% bupivacaine with 1mg dexamethasone at both sites. Post block NRS – 1/10, power – 1/5. Patient also received 6 sessions of dry needling over 4 weeks along with Tab pregabalin 25mg at bed time, Tab paracetamol 250mg BID and Tab nortryptiline 10mg at bed time along with Vit D3 & Vit B12 supplements, with no much improvement in pain score or motor function recovery. A USG guided stellate ganglion block with 1% preservative free lignocaine was administered after a week with no effect on NRS. After a month, Growth Factor Concentrate (GFC) of 4 ml, was derived from patient’s own blood of 8ml, and was administered around affected nerves. Four weeks post GFC injection, patient had NRS of 2/10 at rest and on movement and motor power of 5/5.
Conclusions
There is a lack of clinically available therapeutics for PNI. GFs play important roles in peripheral nerve regeneration, including regulating cellular survival, growth, proliferation, differentiation, migration, neuroinflammation, and neurotrophic factor secretion. At the site of peripheral nerve injury, exogenous local administration of growth factor concentrate derived from platelets, creates microenvironment that supports peripheral nerve repair and regeneration. This in turn, helps pain management and functional recovery of the target muscles. Thus, multimodal, comprehensive approach in management of peripheral nerve injury should be inclusive of growth factor concentrate injection at the site.
References
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Presenting Author
Sweta Salgaonkar
Poster Authors
Sweta Salgaonkar
MD
Seth GS Medical College & KEM Hospital
Lead Author
Topics
- Mechanisms: Biological-Molecular and Cell Biology