Development of new therapy for causalgie using in situ Tissue Engineering.

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As the results of this project, we have already applied the new theory to clinics and reported two clinical cases of chronic pain. Though causalgia is often the result of partial injury to a major nerve, most commonly the median nerve supplying the hand, it is also seen following the digital nerve injury. The preoperative symptoms had become stable and they had been diagnosed by pain clinicians as having CRPS type II accompanied by allodynia, tremor, joint contracture, and vasomotor abnormality. At surgery, nerve sprouting was observed to extend from the proximal and distal sites of the injured nerve to the surrounding tissues. In these two cases, sprouting had also occurred in the distal part of the injured nerve and spread to the areas in which pain was observed. Surgery in the present two cases involved insertion of the nerve stumps into a PGA-collagen tube, thus covering the nerve ends. Hollow PGA resorbable nerve tubes have already been used clinically. Removing the neuroma with associated nerve sprouts and covering the nerve ends with a PGA tube might reduce the pain. Both of our present patients showed functional recovery, as indicated by electrophysiological evaluations, after successful nerve regeneration. Accordingly, peripheral nerve recovery may have an influence on central nerve function to prevent the recurrence of causalgia. Further clinical studies will be necessary to determine whether the tube is also effective for other clinical symptoms of causalgia, such as mirror region, phantom pain. Thus, the clinical outcomes in these cases indicate the possibility of a new surgical approach using a nerve guide tube for resolution of peripheral nerve injury accompanied by causalgia and functional loss.