The Role of Collagen Conduit with Duloxetine and/or Pregabalin in the Management of Partial Peripheral Nerve Injury

Abstract

Abstract Introduction: The objective of this study was to investigate the analgesic effect of using collagen conduit with Duloxetine and/or Pregabalin in the treatment of partial sciatic nerve transection in a rat model of neuropathic pain. Material and Methods: Adult male Sprague-Dawley rats were divided into 5 groups (n=10/group): Group 1 (Nerve damage with no treatment), Group 2 (Nerve damage treated with the application of collagen conduit), Group 3 (Nerve damage treated with the application of collagen conduit and Duloxetine), Group 4 (Nerve damage treated with the application of collagen conduit and Pregabalin), Group 5 (Nerve damage treated with the application of collagen conduit with Pregabalin and Duloxetine). The nerve injury model used to induce neuropathic pain was the partial transection model. Behavioral responses to mechanical and thermal stimuli were tested at baseline before the surgery, day 3 and day 7 post-surgery. Blood samples, Sciatic nerve (SN) and Dorsal Root Ganglion (DRG) were collected 7 days post-surgery. Results: The main finding of this study was in the group treated with collagen conduit and pregabalin. It showed that this treatment group significantly developed less pain with mechanical and thermal behavioral assays when compared to other groups. One of the suggested mechanisms associated in this analgesic effect was the increase in the levels of Interleukin-10 (IL-10). This increase of IL-10 was observed significantly in the injured nerve and the ipsilateral DRG. The groups treated with collagen conduit and duloxetine, and a combination of pregabalin and duloxetine also showed significant reduction in pain at day 7 post surgery. Interleukin 6 and TNF alpha were associated with these respective analgesic effects. 3 Conclusion: Collagen conduit with duloxetine, pregabalin and the combination of both medications helped alleviate neuropathic pain. However the medications are working via different mechanisms. If we look at the role of cytokines only, it seems as if the action of each medication is cytokine specific. Pregabalin reduced the pain by increasing the levels of anti-inflammatory cytokine IL-10, duloxetine decreased the pain by decreasing the levels IL-6 and the combination of the medication decreased the pain by decreasing the levels of pro inflammatory cytokine TNF alpha.