NEUROPATHIC EYE PAIN is a Chronic Pain condition which is often debilitating issue for patients. These patients often see multiple doctors from multiple specialties without pain relief.
How do I know if I have Neuropathic Eye Pain?
Here are some qualities of neuropathic eye pain: if you answer Yes to many of these items below, you may have a component of Neuropathic Eye Pain. The good news is that we have some treatment options that have helped many patients.
• Pain does not improve with artificial tears, Restasis, Xiidra
• Pain does not improve or minimally improves with anesthetics like topical lidocaine drops or even injections.
• Pain is usually constant with occasional relief from unclear reasons, and
moderate to severe in intensity
• Pain has specific qualities, including
burning (C fiber activation) and sharp,
shooting neuralgic pain sensation.
• Pain can have aching and throbbing qualities especially behind the eye
• Microscopic exam of the eye under the slit lamp microscope shows almost no signs of dryness or is completely normal.
• CT scan and/or MRI is all normal yet severe pain persists.
• Precipitating factors may throw a patient into NEP Syndrome:
-Excessive Electronic Screen Use (for some this is as low as 2-3hrs per day).
-Birth Control or certain IUDs or hormonal changes
-previous eye or eyelid or even sinus
surgery, maxillofacial trauma, dental
infection, viral infections, bacterial eye infection
• Over-the-counter drugs such as NSAIDS, codeine, tramadol and even morphine do not reduce pain
• Theory: This chronic neuropathic pain can involve the damage or neurons from the loss
of the cells ability to block magnesium from the
calcium channel, resulting in chronic nerve firing and pain.
• Pain can seem to be coming from behind the eye or around the eye and even sinus area.
• Persistent pain can cause frustration, depression,
anxiety, despair, suicidal thoughts.
• About 50-75% of
patients with neuropathic pain have a moderate to
severe psychiatric diagnosis, often
due to unremitting pain.
What is the Best Way to Treat Neuropathic Eye Pain?
First we start of trying to see if the usual treatments for dry eye help: ie, lid hygiene, warm compresses, non-preserved artificial tears, Xiidra, Restasis, Punctal Plugs, Steroid ointment/drops, Lipiflow, IPL, Autologous Serum, PRP, Prokera/Amniotic membrane. If these do not work often in this order, we try Meibomian Gland Probing with Expression (MGPE). If this does not help relieve the pain, we try MGPE with PRP insertion into the meibomian glands. If this does not work we try MGPE into the Lacrimal Gland. If all these do not help we try Autologous, Adipose Derived Stem Cells into the meibomian glands, lacrimal gland and IV (the theory is that stem cells may help through cell to cell contact, stimulate abnormal cells to work properly). If this does not help, we would try Stem Cell injection into the key nerve ganglion of the eye.
Stem cell therapy: This is investigational.
A friend from Harvard just inplanted the first human in-vitro-expanded- limbal stem cell implantation in which the patient’s limbal stem cells were expanded in vitro from the healthy eye to the unhealthy (chemical burn damaged) eye: it took her 10 YEARS to be able to do this.
Do our dry eye patients have 10 years to wait for proof? This is a problem.
Preliminary studies of autologous stem cell
therapy have shown it to be safe and effective
for treating neuropathic pain in animals and
humans.(Ref 1, 2) Results of the human study showed
a reduction in pain intensity (mean reduction
of 43%) in 78% of patients at six months from
a single administration of stem cells at the
trigeminal pain site.(Ref 2).
But all these stem cell treatments are investigational at this time for Neuropathic Eye Pain.
1. MedicineToday ❙ SEPTEMBER 2015, VOLUME 16, NUMBER 9
2. Vickers ER, Karsten E, Flood J, Lilischkis R. A preliminary report on stem
cell therapy for neuropathic pain in humans. J Pain Res 2014; 7: 255-263.
Journal of Pain Research Dovepress
submit your manuscript | www.dovepress.com
O R IGINAL RESEA R C H
open access to scientific and medical research
Open Access Full Text Article
A preliminary report on stem cell therapy
for neuropathic pain in humans
E Russell Vickers1
Sydney Oral and Maxillofacial
Surgery, NSW, Australia; 2
Ltd, Gordon, NSW, Australia; 3
St Vincents Hospital, Sydney, NSW,
Correspondence: E Russell Vickers
Sydney Oral and Maxillofacial
Surgery, Suite 1401, 520 Oxford
St, Bondi Junction, NSW, Australia
Tel 61 2 9369 2153
Fax 61 2 9369 2154
Objective: Mesenchymal stem cells (MSCs) have been shown in animal models to attenuate
chronic neuropathic pain. This preliminary study investigated if: i) injections of autologous
MSCs can reduce human neuropathic pain and ii) evaluate the safety of the procedure.
Methods: Ten subjects with symptoms of neuropathic trigeminal pain underwent liposuction.
The lipoaspirate was digested with collagenase and washed with saline three times. Following
centrifugation, the stromal vascular fraction was resuspended in saline, and then transferred to
syringes for local injections into the pain fields. Outcome measures at 6 months assessed reduction
in: i) pain intensity measured by standard numerical rating scale from 0–10 and ii) daily
dosage requirements of antineuropathic pain medication.
Results: Subjects were all female (mean age 55.3 years o standard deviation [SD] 14.67; range
27–80 years) with pain symptoms lasting from 4 months to 6 years and 5 months. Lipoaspirate
collection ranged from 102–214 g with total cell numbers injected from 33 million to 162 million
cells. Cell viability was 62%–91%. There were no systemic or local tissue side effects from the
stem cell therapy (n 41 oral and facial injection sites). Clinical pain outcomes showed that at 6
months, 5/9 subjects had reduced both pain intensity scores and use of antineuropathic medication.
The mean pain score pre-treatment was 7.5 (SD 1.58) and at 6 months had decreased to 4.3
(SD 3.28), P 0.018, Wilcoxon signed-rank test. Antineuropathic pain medication use showed
5/9 subjects reduced their need for medication (gabapentin, P 0.053, Student’s t-test).
Conclusion: This preliminary open-labeled study showed autologous administration of stem
cells for neuropathic trigeminal pain significantly reduced pain intensity at 6 months and is a
safe and well tolerated intervention.
Keywords: adipose, stem cells, neuropathic, orofacial, trigeminal
3. Clin Orthop Relat Res. 2018 Feb;476(2):388-397. doi: 10.1007/s11999.0000000000000033.
Stem Cells Combined With Platelet-rich Plasma Effectively Treat Corticosteroid-induced Osteonecrosis of the Hip: A Prospective Study.
Core hip decompression with injection of concentrated bone marrow plus PRP improved pain and function; > 90% of hips in this series were without collapse at a minimum of 2 years. In this preliminary study, successful results were seen when nucleated cell count was high and modified Kerboul grade was low. Further randomized studies are needed to determine this procedure’s efficacy versus core decompression or nonoperative treatment alone.
Concise Review: Altered Versus Unaltered Amniotic Membrane as a Substrate for Limbal Epithelial Cells.
4. CNS Neurosci Ther. 2018 Mar 12. doi: 10.1111/cns.12843. [Epub ahead of print]
Low-dose curcumin stimulates proliferation of rat embryonic neural stem cells through glucocorticoid receptor and STAT3.
METHODS AND RESULTS:
This study shows that low-dose curcumin stimulates the proliferation of NSCs, which is probably by inhibiting the mRNA and protein expressions of GR and directly or indirectly regulating the STAT3 via the synergistic effect of GR and STAT3 pathways and its related signal pathways.
5. SLAS Discov. 2018 Mar 1:2472555218764678. doi: 10.1177/2472555218764678. [Epub ahead of print]
Plate-Based Phenotypic Screening for Pain Using Human iPSC-Derived Sensory Neurons.
Screening against a disease-relevant phenotype to identify compounds that change the outcome of biological pathways, rather than just the activity of specific targets, offers an alternative approach to find modulators of disease characteristics. However, in pain research, use of in vitro phenotypic screens has been impeded by the challenge of sourcing relevant neuronal cell types in sufficient quantity and developing functional end-point measurements with a direct disease link. To overcome these hurdles, we have generated human induced pluripotent stem cell (hiPSC)-derived sensory neurons at a robust production scale using the concept of cryopreserved “near-assay-ready” cells to decouple complex cell production from assay development and screening. hiPSC sensory neurons have then been used for development of a 384-well veratridine-evoked calcium flux assay. This functional assay of neuronal excitability was validated for phenotypic relevance to painand other hyperexcitability disorders through screening a small targeted validation compound subset. A 2700-compound chemogenomics screen was then conducted to profile the range of target-based mechanisms able to inhibit veratridine-evoked excitability. This report presents the assay development, validation, and screening data. We conclude that high-throughput-compatible pain-relevant phenotypic screening with hiPSC sensory neurons is feasible and ready for application for the identification of new targets, pathways, mechanisms of action, and compounds for modulating neuronal excitability.
6. J Orthop Translat. 2017 Apr 9;9:76-88. doi: 10.1016/j.jot.2017.03.005. eCollection 2017 Apr.