. Roberto Ezequiel Heymann and Eduardo dos Santos Paiva received honorariums from Lilly, Janssen-Cilag, Boehringer, Apsen, and Pfizer for speeches and consulting services; Milton Helfenstein Junior received honorariums from Pfizer and Merck Sharp for speeches and consulting services; Daniel Feldman Pollak received honorariums from Lilly, Pfizer, and Merck Sharp; José Eduardo Martinez received honorariums from Sanofi Aventis, for speeches, and Pfizzer, for speeches and consulting services; José Roberto Provenza received honorariums from Roche, Bristol, Ache, and Pfizer to participate in clinical studies with new drugs at PUC-Campinas; Marcelo Cruz Rezende received honorariums from LillyBoehringer, to participate in symposiums, and from Pfizer, for speeches and to participate in sympostiums; valério valim Cristo received honorariums from Roche for presentations, conferences, or speeches, besides financing for studies, teaching organization, or to attend symposiums sponsored by Lilly, Genzyme, and Schering-Plough.

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ReviewThe pain that commonly occurs after brachial plexus avulsion poses an additional burden on the quality of life of patients already impaired by motor, sensory and autonomic deficits. Evidence-based treatments for the pain associated with brachial plexus avulsion are scarce, thus frequently leaving the condition refractory to treatment with the standard methods used to manage neuropathic pain. Unfortunately, little is known about the pathophysiology of brachial plexus avulsion. Available evidence indicates that besides primary nerve root injury, central lesions related to the abrupt disconnection of nerve roots from the spinal cord may play an important role in the genesis of neuropathic pain in these patients and may explain in part its refractoriness to treatment.ConclusionsThe understanding of both central and peripheral mechanisms that contribute to the development of pain is of major importance in order to propose more effective treatments for brachial plexus avulsion-related pain. This review focuses on the current understanding about the occurrence of neuropathic pain in these patients and the role played by peripheral and central mechanisms that provides insights into its treatment.SummaryPain after brachial plexus avulsion involves both peripheral and central components; thereby it is characterized as a mixed (central and peripheral) neuropathic pain syndrome.