Autologous fat grafting seems to alleviate postherpetic neuralgia – a feasibility study investigating patient-reported levels of pain

Abstract

Postherpetic neuralgia (PHN) is a relatively common side effect after an outbreak of herpes zoster (HZ), characterized by chronic neuropathic dermal pain. No effective treatment exists today. Fat grafting has shown promise in alleviating neuropathic pain, yet the exact mechanism of action, at a biological level, is not yet known. We report on the first human study using autologous fat grafting for treating PHN. Our hypothesis was that fat grafting can alleviate pain and improve the quality of life (QoL) in patients suffering from PHN. If successful, this could be a safe, cost-effective alternative to analgesics. This safety and feasibility study aimed to investigate the possible pain-relieving effect of autologous fat grafting on PHN. Ten adult patients suffering from PHN underwent autologous fat grafting to a dermal area of neuralgia, with a 12-week follow up. The primary endpoint was patient-reported pain. Secondary endpoints were patient-reported changes in QoL, and the degree and quality of the neuropathic pain. The pain was measured by using a visual analog scale (range: 0-10). We observed improvements in both the average and maximum level of pain with a reduction of (-4.0 ± 3.1) and (-5.1 ± 3.9), respectively, (Δ mean ± SD), P<0.05. All parameters investigating neuropathic pain were significantly reduced. No improvement was seen in the QoL. The average amount of fat grafted was 208ml. We observed no serious adverse effects. This study suggests that autologous fat grafting can relieve chronic pain resulting from HZ. The next step toward routine clinical translation is to perform a randomized, blinded, placebo-controlled trial with a more extended follow-up period.