Clearing the path to pain-free

Medication may speed up the recovery process and prevent or lessen the pain associated with nerve damage.

Injuries of all kinds set off reactions within the body that can both help and hinder recovery. When it comes to damaged nerves, the sooner the healing process gets underway the better in terms of avoiding acute and potentially chronic pain caused by nerve damage, as found in carpal tunnel or sciatica.

Vancouver Coastal Health Research Institute researcher Dr. Matt Ramer and PhD student and lead author Brittney Smaila published a study in Experimental Neurology that looked at preventing some of the devastating consequences of nerve damage. 

Dr. Matt Ramer is the British Columbia neurotrauma fund professor with ICORD and an associate professor of Zoology at the University of British Columbia (UBC).

For this research, Smaila and colleagues administered an experimental medication called dimethyloxalylglycine (DMOG) to block prolyl hydroxylase domain (PHD) proteins, effectively tricking cells into acting as though oxygen levels were low. The study team found that DMOG blunted certain types of inflammatory macrophage cells that can slow nerve recovery. As a result, damaged peripheral nerves regenerated faster and the return of sensation was accelerated. 

“This experimental treatment effectively changed the environment to make it easier for regenerative immune cells to outnumber damaging ones,” explains Ramer. “By altering the environment in which nerve regrowth takes place, we cleared a path to a smoother recovery.”

“Not only did nerves regenerate faster and more fully, the treatment approach could potentially reduce short- and long-term pain caused by nerve damage.”

By keeping inflammation in check—similar to smoothing out a bumpy road—nerves were able to regenerate and reestablish greater functionality, such as the ability to detect and respond to sensory stimulation, sooner. Similar results were also observed when Ramer and his research team genetically removed PHDs.

“I am very excited about the enhanced nerve regeneration that we have seen,” says Smaila, a PhD student at ICORD and the Department of Zoology at UBC.

“DMOG seems to also have a significant effect on neuropathic pain, which can be even more challenging for patients than sensory-motor deficits from nerve damage in terms of pain management and quality of life.”

An approach that could stop chronic pain from nerve damage in its tracks

The peripheral nerves connect our extremities to the spinal cord and brain. Wounds or compression are common causes of acute injury to these nerves, but they can also be damaged by autoimmune diseases such as Lupus, psoriasis, rheumatoid arthritis, inflammatory bowel disease and celiac disease.

“One to three per cent of all patients who experience a trauma injury of any kind will also experience damage to their peripheral nerves.”

Current treatments for nerve damage can involve intermittently changing the oxygen environment in a patients’ cells using equipment that requires time and resources. Similar or better results may be possible by taking something like a DMOG pill, without the need to alter patients’ oxygen intake.

This study is particularly important for a patient population that often receives few benefits from available pain medications, says Ramer.

“There is no cure for neuropathic pain, and few highly effective treatments for it,” he notes. “Standard first-line treatments, such as opioids and other pain killers, are often insufficient at managing patients’ pain.”

A more effective and less resource-intensive approach to preventing chronic nerve damage and pain could translate into tens of billions of dollars saved in terms of lost productivity and health care costs, Ramer adds. Sparing people from debilitating chronic pain would have incalculable benefits.

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