Stem Cell Lines Released For Neuropathy Research

Today's short but nonetheless important post from healio.com (see link below) announces a breakthrough in future stem cell research for nerve damage. You may have noticed more and more articles appearing over the last two years regarding the successes with stem cell therapy and neuropathy but it's been patchy and generally based on relatively small research studies. Now that a large amount of stem cell lines have been released for research, we can expect much faster progress in this promising line of neuropathy treatment. The article appears to be directed towards lines from the Charcot-Marie-Tooth Association (CMTA) but the widespread ramifications are part of a domino effect in stem cell research. A question of 'watch this space' but progress is being made so hang in there!

New stem cell collection available for neuropathy research
June 22, 2016
 
The New York Stem Cell Foundation Research Institute and the Charcot-Marie-Tooth Association recently announced a new collaboration to make stem cells available to researchers. According to a press release, the stem cell lines represent the largest collection available for a variety of neuropathy disorders of known genetic causation.

The New York Stem Cell Foundation (NYSCF) Research Institute and the Charcot-Marie-Tooth Association (CMTA) originally collaborated in 2014 to collect fibroblasts from patients with Charcot-Marie-Tooth diseases and turn the samples into induced pluripotent stem cell lines. The stem cell lines will be available for investigators through the NYSCF Repository. Of the 19 lines created, 11 are currently available and eight are undergoing reprogramming.

“This important collaboration has resulted in the largest ever number of CMT stem cell lines available for research around the world. This is a milestone for the field,” Susan L. Solomon, chief executive officer and cofounder of NYSCF, said in the release.

Patrick A Livney, chief executive officer of CMTA, said he “is proud of the association’s [Strategy to Accelerate Research] STAR platform, dedicated to finding first treatments for various CMT diseases. As STAR’s progress continues, the CMTA wants to enable and include all stakeholders interested in that mission to join in the effort. This NYSCF collaboration achieves that goal.”

For more information: To order stem cell lines, visit www.nyscf.org/repository.

References:

www.cmtausa.org/

www.nyscf.org/

http://www.healio.com/orthotics-prosthetics/health-care-updates/news/online/%7B7c6b092b-610b-4708-88f9-c53c4fde7d8f%7D/new-stem-cell-collection-available-for-neuropathy-research

The Dangerous Language Of Medical Research

Today's post from updates.pain-topics.org (see link below) is another excellent article from Dr Leavitt, talking about how drugs are often regulated based on several vague words of conclusion from research papers. 'There is no evidence to suggest...' can let governments and regulatory bodies completely off the hook in their decision making about drugs availability. It means that patients need to be constantly alert and conscious of the fact that their necessary medication may be refused on very shaky grounds. It may require some foot-stamping to get your way; especially if you have done all the research and have taken expert advice which suggests that a particular drug could help you considerably. It's rejection may hang on those six words but in fact all they mean is the opposite of what they say - there may be no evidence to suggest but that equally means there may be no evidence to prohibit. Making an ally of your doctor and taking well-researched and factual arguments to him or her may convince the powers that be that you will in fact, benefit from taking such a drug. 'There is no evidence to suggest...can often be a cop-out which will worsen your condition. This article is well-worth reading.

The 6 Worst Words in Evidence-Based Medicine
Posted by SB. Leavitt, MA, PhD Saturday, December 14, 2013

Writing in the November 2013 edition of the Journal of the American Medical Association, R. Scott Braithwaite, MD, MS, from New York University School of Medicine, comments on a deceptive 6-word phrase often used in evidence-based medicine (EBM) that frequently leads to dangerously false inferences for clinical decision making [Braithwaite 2013]. We further contend that, applied to the interpretation and application of pain research — such as relating to the use of opioids analgesics for chronic pain — those 6 words also can encourage poor quality pain management and inexcusable patient suffering.

What are the offending 6 words? They are quite simply, “There is no evidence to suggest….” Braithwaite proposes that this phrase should be banished from the lexicon of EBM and, while this could be important, we also recognize that it could foster uncertainty and doubt that could be discomforting to many professionals and patients in the pain field.

Untested Hypotheses

Braithwaite provides the following statements as examples of nefarious usage of the phrase:
“There is no evidence to suggest that hospitalizing compared with not hospitalizing patients with acute shortness of breath reduces mortality.”

“There is no evidence to suggest that ambulances compared to taxis to transport people with acute GI bleeds reduces prehospital deaths.”

“There is no evidence to suggest that looking both ways before crossing a street compared to not looking both ways reduces pedestrian fatalities.”

As Braithwaite maintains, all of the statements are absurd as a basis for decision making, yet each statement is technically correct since its underlying hypothesis has not been suitably tested to establish contradictory evidence. This presumes a definition of “evidence” that requires formal hypothesis testing in an adequately powered (eg, large sized) and well-designed (eg, randomized, controlled) research study.

Taking this further, based on a prior review article [Smith and Pell 2003], we would add the following statement: There is no evidence to suggest that jumping from an airplane in flight without a parachute as compared with using a parachute is fatal. As the review authors note (somewhat satirically), while there have been anecdotal accounts of persons without parachutes surviving falls from airplanes, it is extremely difficult to recruit subjects for good-quality randomized controlled trials comparing parachute use with no parachute in such circumstances; so, the statement is technically correct, but unproven and misleading.

Based on his observations, Braithwaite proposes that “there is no evidence to suggest” has become a mantra for EBM practitioners in a wide variety of settings. And, he says, rarely is the statement followed by the clarifying aphorism “absence of evidence is not evidence of absence” [also see Altman and Bland 1995] or discussions of more inclusive definitions of “evidence” for affirming the hypotheses in question.

Seeking Clarity & Precision

Braithwaite proposes that, when an intervention potentially may incur significant harm or require large commitments of resources, deciding not to intervene when “there is no evidence to suggest” the favorability of the intervention can be prudent. “However, deciding to intervene when ‘there is no evidence to suggest’ also may make sense,” he writes, “particularly if the intervention does not involve harm or large resource commitments, and especially if benefit is suggested by subjective experience (eg, the qualitative analogue of the Bayesian prior probability).” 

Side Note
Bayesian theory applied to medical research is regaining popularity — albeit, it is difficult for most people to understand — and it provides a mathematical framework for inference or reasoning using probability estimates. The approach can be particularly helpful in judging the relative validity of hypotheses in the face of sparse or uncertain data. While actual calculations can be complex, to evaluate the probability of a hypothesis being “true” an investigator specifies a prior probability — based on current observation/experience, past research, or scientific principles — which is then updated in the light of new, relevant research data to provide a posterior probability (ie, outcome result). An important feature of a Bayesian approach is that it takes into account what already is known or can be estimated, either quantitatively or qualitatively, about the likelihood of research outcomes being valid; if there is absolutely no (zero) prior probability to support a hypothesis, then research outcomes — whether favorable or unfavorable — are usually unlikely to be valid and reliable. In many respects, this might be viewed as a statistical application of the “Bradford Hill Criteria” for establishing cause-effect relationships [as discussed in Part 11 (here) of our series on “Making Sense of Pain Research].

Braithwaite further maintains that a fundamental problem with the phrase “there is no evidence to suggest” is that it is “ambiguous while seeming precise.” What does “there is no evidence to suggest” really mean when used to argue against some intervention?

Does it mean that the intervention has been proven to have no benefit? That some evidence does exist, but it is inconclusive or insufficient? That outcomes are somewhat equivocal, with risks exceeding benefits for some patients but not others? Each has a subtly different meaning affecting decision making; whereas, simply stating “there is no evidence to suggest” circumvents the experience or clinical intuition of healthcare providers. Furthermore, as Braithwaite notes, many decisions are particularly sensitive to patient preferences and, when the favorability of an intervention is unclear, “there is no evidence to suggest” may “inhibit shared decision making and may even be corrosive to patient-centered care.”

According to Braithwaite, most practitioners make patient-centered decisions every day without high-quality (eg, randomized controlled trial) evidence as a guide, and those decisions are not always wrong. Furthermore, principles of EBM make it clear that an evidence-based approach was never intended to entirely exclude information derived from clinical experience and intuition — which amounts to a qualitative prior probability in a Bayesian sense.

He recommends that practitioners and researchers make concerted efforts to banish “there is no evidence to suggest” from their professional vocabularies. Instead, they could substitute one of the following 4 phrases, each of which has clearer implications for decision making:
“Scientific evidence is inconclusive, and we don’t know what is best” (corresponding to an uninformative or ambiguous Bayesian prior probability).

“Scientific evidence is inconclusive, but my experience or other knowledge suggests ‘X’” (corresponding to an informative, qualitative Bayesian prior probability supporting ‘X’).

“This has been proven to have no benefit” (if valid evidence indeed exists to confirm this).

“This is a close call, with risks exceeding benefits for some patients but not for others.”

Braithwaite asserts that each of the 4 statements would lead to distinct inferences for decision making and could improve clarity of communication with patients. Finally, he says, “Informed implementation of EBM requires clearly communicating the status of available evidence, rather than ducking behind the shield of 6 dangerous words.”

False Arguments Over Opioids for Chronic Pain

For quite some time, a very outspoken and opinionated group of healthcare professionals in the United States has been arguing against the long-term use of opioids for chronic noncancer pain, based essentially on the premise “there is no evidence to suggest that the benefits of this therapy outweigh its potential risks.” In fact, going further — by relying on similar logic and bolstered by low-quality, invalid, or misinterpreted evidence — they assert that overwhelming risks negate any benefits. The group also went so far as to petition the FDA to make the labeling of all extended-release (ER) and long-acting (LA) prescription opioids more restrictive [first discussed in an UPDATE here]. Even though the petition’s demands were largely rejected by the FDA in updated product-labeling [see UPDATE here], opioid opponents have persisted in their campaign.

Indeed, it is acknowledged that there is virtually no clinical research evidence of good quality examining the efficacy and safety of opioid analgesics prescribed long-term for chronic pain. And, in their labeling-change mandates, the FDA also requires manufacturers to conduct longer duration trials of ER/LA-opioids, including evaluations of serious risks, such as misuse, abuse, addiction, overdose, and death, as well as the risks of developing increasing sensitivity to pain (hyperalgesia).

Meanwhile, the opioid opponents have been using the current lack of evidence as evidence itself to support what might be called argumenta ad ignoratum, or “appeals to ignorance,” as discussed in Part 12 of our “Making Sense of Pain Research” series [here]. In the absence of any high-quality research evidence to the contrary, the opponents have used their own interpretations of data on opioid-related abuse, addiction, deaths, and other risks to arrive at an artificial Bayesian prior probability of harm — and have successfully foisted fallacious inferences on the public.

Additionally, they are most likely driven by a personal set of prior probabilities — coming from likeminded peers or individual experiences with select patients — that help guide the calculus of their conclusions. Essentially, they have fabricated their own rendition of Braithwaite’s second statement above to claim, “Scientific evidence is inconclusive, but my experience or other knowledge suggests that opioids are ineffective and unsafe in the treatment of chronic noncancer pain.”

However, using similar evidence deficits and prior probabilities informed merely by empiricism (eg, anecdotal observations), there are other important arguments about opioids for chronic pain that can be stated:
There is no evidence to suggest that opioid-induced hyperalgesia is a frequent clinical occurrence in human subjects administered opioids long-term for any type of pain, or which patients might be most affected.

There is no evidence to suggest that there is an inordinately high incidence rate of de novo, iatrogenic addiction among patients with chronic pain prescribed long-term opioid analgesics.

There is no evidence to suggest that significant numbers of patients with chronic pain do not or cannot benefit from opioid analgesia.

Other, similar, arguments could be expressed that cast doubts on concerns about the efficacy and safety of opioids for chronic pain. But, in all cases, such doubts are motivated by uncertainty — or, an “ambiguous Bayesian prior probability” — and a most objective and unbiased premise could be a variation of Braithwaite’s first statement above; “Until there is good-quality evidence available we cannot reach definitive conclusions.” Meanwhile, using a lack of evidence to argue for or against opioids for chronic pain becomes a cruel game of sorts in which nothing is scientifically established and patients who presently do or prospectively could benefit from such therapy are the losers.

Ubi Dubium, Ibi Intellectum

If we accept Braithwaite’s proposal to eschew the use of “there is no evidence to suggest” as a valid argument against a therapy or intervention, it also raises nagging doubts about the legitimacy of rejecting certain questionable modalities for pain management because they have little if any high-quality evidentiary support. A number of complementary and alternative medicine (CAM) modalities immediately come to mind: eg, homeopathy, reflexology, energy-field therapies (eg, Reiki, etc.), biomagnetic therapy, some variations of acupuncture, and others.

In most cases, high-quality clinical trials are absent and we are left with observational or anecdotal evidence at best. With certain approaches (eg, homeopathy, Reiki, and others), there is no presently-known biological rationale or plausibility to serve as a prior probability of efficacy. Still, there are ample examples of patients with pain being helped by each of the treatments — an informative prior probability — even if the outcomes are primarily due to placebo effects. So, should those CAM approaches be rejected outright as worthless on the basis of “there is no evidence to suggest that they are clinically effective for pain”?

Indeed, many critics have made strong, rational arguments for unequivocally rejecting most CAM approaches on the basis of absent or inadequate supportive evidence and/or the lack of biological plausibility [eg, see Science Based Medicine blog]. Despite those contentions, and in view of Braithwaite’s perspective, it would appear that less absolutist and more definitive statements are needed. And, these must not rely primarily on the absence of evidence as evidence against CAM approaches and any prior probabilities must be taken into account, including those based on limited observational or anecdotal data.

In many cases, prior probability or plausibility may be so low that the respective CAM approach is still deemed ineffective. But, in other instances, this could encourage “suspended disbelief” until further investigation via high-quality research is possible. Many practitioners and patients may be discomforted or irritated by the degree of uncertainty and doubt this tolerates. And, a dilemma may be that, as with the parachute example above, there may never be definitive research to make strictly evidence-based pain management decisions. However, a fundamental theme of these UPDATES, as well as our “Making Sense of Pain Research” educational series has been Ubi Dubium, Ibi Intellectum, or “Where There Is Doubt, There Can Be Understanding” [click to download series PDF].

REFERENCES:
> Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ. 1995;311(7003):485 [access here].
> Braithwaite RS. EBM’s Six Dangerous Words. JAMA. 2013;310(20):2149-2150 [access by subscription here].
> Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ. 2003;327(7429):1459-1461 [abstract here]

http://updates.pain-topics.org/2013/12/the-6-worst-words-in-evidence-based.html

A Simple Start To Your Neuropathy Research

Today's post from bizpr.ca (see link below) is useful press-release for those meeting neuropathy for the first time. It gives a simple (though not comprehensive) guide to what's going on with your nerves when neuropathy symptoms appear. Not a bad start but you may wish to explore the disease further and do more of your own research. Nevertheless, we all have to start somewhere and if your doctor's explanation has left you more confused than where you started, this article is a handy guide.

Neuropathy – Key Points, Symptoms, and Conditions to be Lead
July 16, 2016

Neuropathy is a nerve issue typically relating to the peripheral nerves. It can be caused by a variety of underlying medical conditions. In some cases, it can occur with seemingly no cause, termed “idiopathic” neuropathy.

Some key points to note about neuropathy:
People with diabetes are more susceptible to neuropathy. In fact, a part of diabetes care includes regular testing for neuropathy.
There are three types of nerves that can be affected: motor nerves, autonomic nerves, and sensory nerves.
In addition to diabetes, the following can all lead to neuropathy: physical trauma, infection, repeated injuries, metabolic complications, drugs, and metabolic problems can all lead to neuropathy.
In cases where the neuropathy is caused from a toxin, removing exposure to the toxin can prevent the condition from progressing and causing further nerve damage.
The type of symptoms experienced with neuropathy can also vary greatly, depending on the type of nerves that are being affected:
Motor nerves – These types of nerves control power and movement. This type of neuropathy typically causes weakness in the hands, the feet, or both.
Autonomic nerves – These nerves control various systems of the body, including the bladder and gut. This type of neuropathy typically causes changes in the heart rate, sweating, and blood pressure.
Sensory nerves – These nerves are the ones in charge of sensations in and on the body. This neuropathy can cause sensations of tingling, numbness, weakness, or even pain in the hands and feet.
There are various conditions that can lead to neuropathy. While roughly 30% of neuropathy conditions are from unknown causes, the rest are typically attributed to:
Diabetes– This is the most common cause of neuropathy. The reason being is that high blood-sugar damages nerves, so poorly controlled diabetes tends to damage the nerves.
Chronic liver disease
Connective tissue diseases – Rheumatoid arthritis and several other diseases that affect connective tissues can cause neuropathy.
Cancers – Some cancers can lead to neuropathy, such as multiple myeloma and lymphoma.
Vitamin deficiencies – Deficiencies in vitamins folate and B-12.
Toxins – Things such as insecticides or various solvents.
Drugs – Chemotherapy and HIV medication can cause damage to the peripheral nerves.
Excess alcohol consumption – Repeated high levels of blood alcohol can cause nerve damage.
Certain inflammatory issues – Examples include coeliac disease and sarcoidosis.
Chronic kidney disease – The kidneys are responsible for balancing various chemicals in the body, including salt. Imbalances due to the kidneys not functioning properly can lead to peripheral neuropathy.

Diagnosis of neuropathy typically includes questions pertaining to the specific symptoms, general health and medical conditions, family history, medications, alcohol consumption, and the sexual history of the patient. Next is an examination, nerve conduction studies, electromyography, and a skin or nerve biopsy.

Read more at: http://acueastwest.com/neuropathy/

http://www.bizpr.ca/2016/07/16/neuropathy-key-points-symptoms-conditions-lead/

Research Into Nerve Pain Patience Is A Virtue

 Today's post from foundationforpn.org/ (see link below) tries to remove the feeling that many people living with neuropathy have, that there is very little research and thus very little progress being made in the medical field of neuropathy. This blog agrees and frequently tries to highlight new research studies, however medically complex for the reader, to show that there is a great deal of work being done behind the scenes. The problem is that the time spans between ideas, research, study, tests and evaluations and products on the pharmacists' shelves for patients can be enormous. This is frustrating for current patients but it is surely better to know what's going on and be aware of the fact that much is being done, than be kept in the dark and have the feeling that the medical world is ignoring our plight; even if it means waiting years for concrete results.
 

International Research on Peripheral Neuropathy

foundationforpn.org/ March 7, 2016

It is not unusual for peripheral neuropathy patients, their caregivers and loved ones to be heard wishing for research on PN that may bring hope for better treatments or even a cure. Many people share the perception that little or no research is occurring on peripheral neuropathy leaving them frustrated and sometimes even angry.

In fact, research is happening all over the world. ClinicalTrials.gov is a Web-based resource that provides patients, their family members, health care professionals, researchers, and the public with easy access to information on publicly and privately supported clinical studies on a wide range of diseases and conditions. The Web site is maintained by the National Library of Medicine (NLM) at the National Institutes of Health (NIH). As March 1, 2016, ClinicalTrials.gov identified 1745 studies related to peripheral neuropathy since it first started collecting data in 2007.* 561 studies listed there are still active. The map above shows that 46% of the research is taking place in the U.S. but 29% is also taking place across Europe.

The Foundation for Peripheral Neuropathy uniquely supports PN research through the Peripheral Neuropathy Research Registry (PNRR). Currently, limited data exist to define characteristics of peripheral neuropathy patients with neuropathic pain. In a groundbreaking step to learn more about PN and to find a cure for the debilitating condition, the Foundation for Peripheral Neuropathy launched the first ever national Peripheral Neuropathy Research Registry (PNRR) focused on Diabetic, Chemotherapy-Induced, HIV/AIDS and Idiopathic neuropathies. The data in the PNRR aims to help researchers access detailed genotypic and phenotypic history and neurological examination information about people with painful and non-painful peripheral neuropathies. This Research Registry will facilitate both basic and clinical research studies that are expected to improve understandings of the etiology and pathogenesis of PN. Ultimately, the major goal of the Registry is to improve the ability to diagnose, treat and prevent peripheral neuropathy.

* The ClinicalTrials.gov results database was launched in September 2008 to implement Section 801 of the Food and Drug Administration Amendments Act of 2007 (FDAAA), which requires the submission of “basic results” for certain clinical trials, generally no later than 1 year after their Completion Date. The submission of adverse event information was optional when the results database was first released but was required beginning in September 2009. Results information for registered and completed studies is submitted by the study sponsor or principal investigator in a standard, tabular format without discussions or conclusions. The information is considered summary information and does not include patient-level data.

For more information on how clinical trials work and for featured clinical trials visit the Clinical Trials page on our website

 

 https://www.foundationforpn.org/2016/03/07/5016/

The Rapid Rise Of Stem Cell Research For Nerve Pain

Today's post from consultqd.clevelandclinic.org (see link below) takes a rather complex look at developments in stem cell research for neuropathic pain and concludes that significant progress is being made. It's still at the rodent-lab-testing stage but seems much closer to a successful outcome than many studies that we read about. The article is not particularly easy reading for the layman but you can get the gist of what's being discussed. Yet again, this is evidence of the spin-off potential of the current 'war on opioids', which seems to have shaken up the pharmaceutical industry research departments, to the point where they are seriously investigating new possibilities in anticipation of draconian laws restricting opioid distribution. Interesting article.

Stem Cell Therapy for Neuropathic Pain: New Findings Show Promise
Animal studies demonstrate effectiveness  Consult QD Aug. 10, 2016

Stem cell research at Cleveland Clinic could pave the way for an entirely new approach to chronic pain treatment that reduces medicine’s current reliance on opioid therapy for intractable pain. The modality also shows promise as a tool to reverse opioid tolerance (OT) and opioid-induced hyperalgesia (OIH), particularly problematic side effects of opioid therapy. Jianguo Cheng, MD, PhD, and his colleagues at Cleveland Clinic have developed patented methods of attenuating opioid tolerance.

Animal studies by Dr. Cheng and his colleagues have demonstrated the effectiveness of mesenchymal stem cell (MSC) transplantation in reducing hyperalgesia due to nerve injury. The group’s work has shown MSC transplantation’s effectiveness in reducing pain induced by sciatic nerve injury in rats and mice. MSC transplantation significantly reduced pain sensitivity evaluated by foot withdrawal thresholds in animals in response to thermal or mechanical stimulation. These cells produced immune modulatory and anti-inflammatory effects, promoted sensory nerve repair, and showed strong analgesic properties that could provide a safer and more effective alternative to current treatment modalities, in the management of neuropathic pain, says Dr. Cheng, Professor of Anesthesiology and Director of the Cleveland Clinic Multidisciplinary Pain Medicine Fellowship Program.

Pain medicine researchers are searching for an alternative to opioid therapy because neuropathic pain often does not respond to morphine and other opioids. Opioid analgesics can also lead to a variety of complications, ranging from itching and constipation to dependence, addiction, respiratory depression and death.

About 30 percent of neuropathy cases are caused by nerve damage associated with diabetes. However, hundreds of diseases are linked to neuropathic pain. Sources of neuropathic pain include alcoholism, amputation (which can result in phantom pain), some chemotherapy drugs (for example, Cisplatin®, Paclitaxel®, Vincristine®), radiation therapy, complex regional pain syndrome type II, trigeminal neuralgia, shingles, spinal stenosis, and central nervous system disorders, such as Parkinson disease and multiple sclerosis.

Recent research by Dr. Cheng and his group has yielded new discoveries that bode well for MSC transplantation as a potential future treatment modality. One investigation compared the analgesic effects of MSC derived from bone marrow with MSC derived from adipose tissue. Adipose-derived cells were found to be as efficacious as bone marrow-derived cells in reducing neuropathic pain in rats. The finding suggests that stem cell therapy could offer a practical option because stem cells from adipose tissue are relatively easy to obtain.

Recent investigations by Dr. Cheng and his colleagues comparing the analgesic effectiveness of intrathecal versus intravenous methods of MSC transplantation show both methods to be equally effective. The finding has important implications because intravenous transplantation of MSC could offer a safer and more expeditious route of delivery than intrathecal transplantation.

“We originally thought that stem cells would have to be introduced intrathecally in order to reduce pain, and that stem cells introduced intravenously would pass through the lungs and fail to produce analgesia,” says Dr. Cheng. “The finding that intravenous transplantation is as effective as intrathecal transplantation is encouraging.”

Dr. Cheng’s group has also discovered that MSCs can be found in the area surrounding the injured nerve following MSC transplantation. “For reasons we do not yet fully understand, these cells have the ability to migrate to the injury site to promote repair of the injured nerve fibers,” Dr. Cheng says. “The cells can sense the injury’s location and travel to it.”

Although many questions must be answered before it can be known whether stem cell therapy is safe and effective for humans, some small patient studies show potential, Dr. Cheng says. According to one observational study in Australia, MSC transplantation reduced pain in patients suffering from trigeminal neuralgia, a particularly difficult condition to treat. “Though the findings are preliminary, the study provides some evidence that what we have learned in the laboratory can be translated to clinical use,” Dr. Cheng says.

Dr. Cheng’s team has achieved analgesia with MSC transplantation from rats to mice, providing early evidence that stem cells’ anti-inflammatory and immuno-modulatory properties can be transferred between species. An important pre-clinical study will be to see whether the transplantation of human stem cells to animals also can produce analgesic and anti-tolerance effects, Dr. Cheng says.

Dr. Cheng’s team presented research at the 2016 annual meeting of the American Academy of Pain Medicine showing MSC’s potential to reverse opioid tolerance and opioid-induced hyperalgesia, problems that can compromise the safety and efficacy of opioid therapy. Intravenous transplantation of bone marrow-derived MSC significantly attenuated OT and OIH in animals whether the transplantation was performed seven days before or 14 days after the initiation of daily morphine injections. These data demonstrate that MSC transplantation can not only prevent the development of OT and OIH but can also reverse it.

https://consultqd.clevelandclinic.org/2016/08/stem-cell-therapy-neuropathic-pain-new-findings-show-promise/?utm_campaign=crowdfire&utm_content=crowdfire&utm_medium=social&utm_source=twitter