About Glia, Schwann cells and pain
Schwann cells are peripheral glia cells and might also pay an important role in pain states like post herpetic pain. Recent attention is focusing on the glia, their receptors and the cytokines they secrete. These all are now known to have a major influence in neuropathic or gliopathic pain.
Schwann cells become activation in response to infection and trauma and, as central glia, these cells releases a number of neuro excitatory substances.
Therefore, Schwann cells and nervi nervorum could be an additional targets for the treatment of post herpetic pain.
Glia modulators in gliopathic pain, topical vitamin D
The authors then present the drugs potential useful in the treatment of glial cell activation such as naloxone, naltrexone, minocycline, Pentoxifyllline, propentofylline, AV411 (ibudilast) and interleukin 10. All these drugs could be used systemically or even topically.
- High dose topical vitamin D would appear to offer particular promise because vitamin D has the ability to both reduce glial inflammation and reduce nitric oxide production.
Vitamin D and neuropathic pain
Evidence suggests that vitamin D plays a role in glia modulation. In an observational study of diabetic patients type II with neuropathic pain, all 51 patients were 25-hydroxy vitamin D (25D) insufficient. With a mean concentration of 18 ng/mL (insufficient: serum 25D concentration less than 24 ng/mL).
After 3 months of repletion with cholecalciferol (vitamin D3) tablets (mean dose, 2059 IU). Vitamin D repletion resulted in a significant reduction in pain scores on both the VAS and MPQ at −48.5% and −39.4%, respectively. In another study vitamin D deficiency was more prevalent in patients with diabetes type II than the controls.
Institute for Neuropathic Pain (INP)
In our clinic we often treat these intractable pain patients with topical creams, consisting of Phenytoin, Amitriptyline, Ketamine, Gabapentine, Baclofen. And orally with glia modulators such as Palmitoylethanolamide (PEA).
Topical high dose vitamin D might be an interesting treatment option to be explored!
Jan M. Keppel Hesselink, MD, PhD, and David J. Kopsky, MD, November 2010
‘About Glia, Schwann cells and pain’
Watch our video’s about Neuropathy.
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