PRP for Diabetic Neuropathy

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Increases in circulating blood sugar, as seen in diabetes mellitus, can lead to significant tissue damage. The size of the nerves tapers down as they course from the spinal cord to the tips of our fingers and toes. The small nerve fibers are very susceptible to damage from diabetes and this can manifest as pain and/or numbness that typically begins in the toes and gradually ascends up the leg in a symmetric pattern. This is called diabetic neuropathy and is the most common cause of what is commonly referred to simply as “neuropathy”. This has been a very difficult disease to treat and until now, the focus has been on symptom management through medications. Below is an abstract in a recent issue of Pain Medicine that illustrates a novel treatment approach using platelet-rich plasma (PRP) for diabetic neuropathy. In this randomized control trial, subjects in the PRP treatment group had significant improvements in pain and numbness with results that persisted up to six month (the length of the study). These results give us optimism about the potential benefits of this very safe therapy to address a debilitating condition.

The providers at CHARM are able to implement this treatment utilizing ultrasound guidance with very high-quality PRP produced by our in-house laboratory. If anyone is interested in discussing this treatment, please feel free to contact the physicians at CHARM.

Abstract:

Objective

To evaluate the clinical effect of perineural platelet-rich plasma (PRP) injection for pain and numbness alleviation in diabetic peripheral neuropathy (DPN).

Study Design

A randomized prospective clinical trial.

Setting

Pain clinic and Rheumatology and Rehabilitation Departments, Assiut University Hospital.

Methods

Sixty adult patients with type II DM accompanied by DPN of at least six months’ duration were assessed by modified Toronto Clinical Neuropathy Score (mTCNS) and randomly allocated into two groups. Group I underwent ultrasound-guided perineural PRP injection and medical treatment, and Group II received medical treatment only. Patients were followed up at months 1, 3, and 6 with regard to pain and numbness visual analog scale (VAS) and mTCNS scores.

Results

Significant improvement was recorded in pain and numbness VAS scale scores in group I vs group II (P ≤ 0.001 during the whole study period for both parameters); at the same time, mTCNS improved in group I in comparison with group II with P = 0.01, 0.001, and <0.001 at months 1, 3, and 6, respectively.

Conclusions

Perineural PRP injection is an effective therapy for alleviation of diabetic neuropathy pain and numbness and enhancement of peripheral nerve function.

Reference:

Manal Hassanien, MD, Abdelraheem Elawamy, MD, Emad Zarief Kamel, MD, Walaa A Khalifa, MD, Ghada Mohamed Abolfadl, MD, Al Shimaa Ismael Roushdy, MD, Randa A El Zohne, MD, Yasmine S Makarem, MD, Perineural Platelet-Rich Plasma for Diabetic Neuropathic Pain, Could It Make a Difference?, Pain Medicine, Volume 21, Issue 4, April 2020, Pages 757–765, https://doi.org/10.1093/pm/pnz140

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