Neuropathic pain is a common indication that affects 116 million people in the US – more than heart disease, brain disease and diabetes combined. Often, these patients are unable to work, and it is estimated this costs the US economy $635bn a year. Despite this huge personal and economic cost, the treatment options for neuropathic pain are severely limited, mainly due to efficacy or safety concerns.
One treatment option involves the use of opioid therapy. However, there are two main problems with this therapy: opioid tolerance (OT) and opioid induced hyperalgesia (OIH). OT occurs when the body adjusts to frequent opioid doses and the treatment becomes less effective. OIH occurs when patients develop an increased sensitivity to noxious stimuli. When combined, OT and OIH often lead to drug abuse. Statistics from the Centers for Disease Control and Prevention (CDC) show overdoses involving prescription opioids led to more than 15,000 deaths in the US in 2015. These safety concerns prevent opioids from being recommended as a first-line therapy.
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At the 6th International Congress on Neuropathic Pain (NeuPSIG) in Gothenburg, Sweden, Dr. Jianguo Cheng highlighted how mesenchymal stem cells (MSCs) may be used to prevent OT and attenuate OIH. In an animal study conducted in 2016, it was found that when MSCs were injected intravenously (MSC-TP) into rats, they prevented OT and reversed it in models where OT had already been established. In rats suffering from OIH, an MSC transplant was shown to attenuate OIH and reverse it in cases where it had already been established.
These results show that MSCs possess a strong anti-tolerance and anti-hyperalgesic effect. These effects are most likely mediated by the inhibitory action of MSCs on microglia and astrocytes, which are overexpressed upon morphine injection, thereby reducing inflammation. The results are made even more promising by the fact no adverse effects were observed in the 2016 study.
This study is significant, as it showcases a relatively simple, innovative therapy designed to treat neuropathic pain, OT, and OIH. A MSC transplant shows promise in the ability to fundamentally reduce the risk of opioid overdose and abuse, improving the quality of life of millions of patients and decreasing the long-term costs of pain care.
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