One redditor asked me what new treatments for small fiber neuropathy are on the horizon.
There’s one drug specifically worth nothing. That is, suzetrigine — even though it’s going to be licensed for moderate-to-severe acute pain for now, they are looking to extend the label to neuropathic pain as well (DPN).
It is an interesting drug and in some ways unlike anything available on the market at the moment..
1. It is a selective Nav1.8 channel inhibitor.1 What that means is that it might have less side effects than other non-selective blockers (like amitriptylline which also blocks Nav1.5 and causes cardiac side effects2).
2. It is supposed to work in the peripheral nervous system, specifically in dorsal root ganglia3 (where the sensory neurons process pain and other sensory stimuli before they enter the spinal cord). So, if it doesn’t affect the central nervous system — specifically, the brain — that hopefully means less side effects as well, as opposed to ALL neuropathic painkillers on the market (again, antiepileptics, antidepressants etc.).
3. SCN10A gene encodes Nav1.8 channels.4 SCN10A gain-of-function mutation has been described in some patients with small fiber neuropathy.5,6 Which means that it might be an excellent drug specifically for that subgroup of patients, as it will work precisely where it’s needed and until gene editing becomes a thing, it’s hard to imagine a better drug for this particular group of patients.
There was also a question about psilocybin — I’m aware of a few studes that explored its potential of reducing neuroinflammation.7,8,9 Psilocybin studies are still in their infancy due to several decades of a setback due to war on drugs. Unfortunately, I don’t think there are any worthwhile psilocybin studies that would translate to neuropathic pain treatment any time soon.
HGH — I don’t know much about its application in neuropathies, so I can’t answer this at the moment, but I will look at the research.
- https://news.vrtx.com/news-releases/news-release-details/vertex-announces-positive-results-vx-548-phase-3-program ↩︎
- Chen X, Zhu C, Zhou H, et al. Key Role of the Membrane Trafficking of Nav1.5 Channel Protein in Antidepressant-Induced Brugada Syndrome. Frontiers in Physiology. 2018;9. doi:https://doi.org/10.3389/fphys.2018.01230 ↩︎
- Ramachandra R, McGrew SY, Baxter JC, Howard JR, Elmslie KS. NaV1.8 channels are expressed in large, as well as small, diameter sensory afferent neurons. Channels (Austin). 2013 Jan 1;7(1):34-7. doi: 10.4161/chan.22445. Epub 2012 Oct 12. PMID: 23064159; PMCID: PMC3589279. ↩︎
- https://www.ncbi.nlm.nih.gov/gene?Db=gene&Cmd=ShowDetailView&TermToSearch=6336 ↩︎
- Dabby R, Menachem Sadeh, Broitman Y, Yosovich K, Dickman R, Leshinsky-Silver E. Painful small fiber neuropathy with gastroparesis: A new phenotype with a novel mutation in the SCN10A gene. Journal of Clinical Neuroscience. 2015;26:84-88. doi:https://doi.org/10.1016/j.jocn.2015.05.071 ↩︎
- Faber CG, Lauria G, Ingemar S. J. Merkies, et al. Gain-of-function Na v 1.8 mutations in painful neuropathy. Proceedings of the National Academy of Sciences. 2012;109(47):19444-19449. doi:https://doi.org/10.1073/pnas.1216080109 ↩︎
- Vann Jones SA, O’Kelly A. Psychedelics as a Treatment for Alzheimer’s Disease Dementia. Front Synaptic Neurosci. 2020 Aug 21;12:34. doi: 10.3389/fnsyn.2020.00034. Erratum in: Front Synaptic Neurosci. 2020 Oct 26;12:607194. doi: 10.3389/fnsyn.2020.607194. PMID: 32973482; PMCID: PMC7472664. ↩︎
- Mason NL, Szabo A, Kuypers KPC, et al. Psilocybin induces acute and persisting alterations in immune status in healthy volunteers: An experimental, placebo-controlled study. Brain Behavior and Immunity. 2023;114:299-310. doi:https://doi.org/10.1016/j.bbi.2023.09.004 ↩︎
- Burmester DR, Madsen MK, Szabo A, et al. Subacute effects of a single dose of psilocybin on biomarkers of inflammation in healthy humans: An open-label preliminary investigation. Comprehensive Psychoneuroendocrinology. 2022;13:100163-100163. doi:https://doi.org/10.1016/j.cpnec.2022.100163
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