Background & Aims
Intercostal neuralgia is a symptom characterized by neuropathic pain along the dermatomes of intercostal nerves. Definitive treatment for intercostal neuralgia has not yet been established. Currently, several approaches have been reported to alleviate intercostal neuralgia such as systemic medication, cryoablation, prolotherapy, platelet-rich plasma (PRP) and surgical approach.2 This case report will discuss the effect of PRP in patient with intercostal neuralgia refractory to systemic medication, cryoablation and prolotherapy.
Methods
A 52-year-old female presented to pain clinic due to chronic pain on left thoracal region. Patient had history of simple fracture on 10th left costae 10 months before. After undergoing conservative treatment, patient complained of sharp pain on left thoracal region and eventually turned dull with time. Pain was characterized as constant dull pain, with baseline VAS of 3-4 and VAS >5 during the attack. In the previous month, there was an increase in pain intensity with disturbance of sleep and daily activities. Cryoablation and prolotherapy were attempted in order to treat the pain; however, the effect was insignificant. Patient then scheduled for PRP injection on left tenth thoracal intercostal nerve. First injection of PRP managed to produce 50% pain relief, and complete pain relief was achieved after second injection.
Results
Neuropathic pain is believed to be derived from hyperexcitability of injured neuron due to incomplete healing process.2 PRP may retrigger inflammatory process and promote tissue repair.3 The goal is to recover normal membrane biophysical properties, thus resulting in relief of neuropathic pain.2
PRP may stimulate nerve regeneration process by Schwann cells proliferation, migration and stabilization, vascular regeneration, and promotion of axonal regeneration.4,5 Proliferation and migration of Schwann cells facilitate Bungner band formation and promote axonal growth.5 Schwann cells also contribute to axon membrane stabilization by differentiation into myelin sheath.5 PRP contains VEGF that promotes angiogenesis, resulting in increased vascularization, promoting axonal growth and thus the survival of the neuron.5
Conclusions
Neuropathic pain is believed to be derived from hyperexcitability of injured neuron due to incomplete healing process. PRP may retrigger inflammatory process and promote tissue repair. Recovering membrane biophysical properties through complete tissue repair will result in pain relief. PRP has advantage over systemic drugs and other techniques because it was originated from autologous blood, easily obtainable at low cost, with no known significant side effect.
PRP may be a promising modality to relieve neuropathic pain by facilitating Schwann cells migration and regeneration, revascularization and promoting axon growth. Limitations of studies using PRP in neuropathic pain include various methods of PRP production process, PRP dose, and the use of activating agent. Further study is needed to determine specific characteristic for PRP used. Standardization of PRP quality and production process have to be established in order to discover its potential in various condition.
References
1. Wei J, Gao S, Li W, et al. Percutaneous Endoscopic Intercostal Neurectomy for Refractory Intercostal Neuralgia. Pain Physician. 2021; 24: E1147-53.
2. López JC, Cortés H, Ceballos EG, Pizarro LQ. Platelet-rich plasma in treating peripheral neuropathic pain Preliminary report. Rev Soc Esp Dolor. 2018; 25(5): 263-70.
3. Kuffler DP. Platelet-Rich Plasma and the Elimination of Neuropathic Pain. Mol Neurobiol. 2013; 48(2): 315-32.
4. Sánchez M, Garate A, Delgado D, Padilla S. Platelet-rich plasma, an adjuvant biological therapy to assist peripheral nerve repair. Neural Regen Res. 2017; 12(1): 47-52.
5. Wang S, Liu X, Wang Y. Evaluation of Platelet-Rich Plasma Therapy for Peripheral Nerve Regeneration: A Critical Review of Literature. Front Bioeng Biotechnol. 2022; 10: 808248.
Presenting Author
Meliani Anggreni
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Post-surgical/Post-traumatic Chronic Pain