Pain in Avulsion of the Brachial Plexus

Parry, C. B. Wynn

doi:10.1227/00006123-198412000-00039

Cited by 66 publications

(36 citation statements)

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“…These data are consistent with classic observations (23,27) and may account for some of their therapeutic specificities, particularly the good efficacy of surgical procedures (e.g. dorsal root entry zone lesions) for pain paroxysms in plexus avulsion (33).…”

Section: Discussionsupporting

confidence: 89%

Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Attal

Fermanian

et al. 2008

Pain

257

145

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Section: Discussionsupporting

confidence: 89%

Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Attal

Fermanian

et al. 2008

Pain

257

145

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“…45 Brachial plexus avulsion pains have been dichotomized into either continuous, often burning or throbbing pain and likely involving thalamic neuroplasticity, or shooting paroxysms associated with dorsal horn hyperactivity. 48,49 Both phantom limb pain after amputation and deafferentation pain after BPA fulfill a recently revised definition of neuropathic pain as pain caused by a lesion or disease of the somatosensory system. 27 Neuropathic pain symptom severity and duration are often greater than other forms of chronic pain, leading patients and clinicians to consider neurosurgery.…”

mentioning

confidence: 99%

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Pereira

Boccard

Linhares

et al. 2013

FOC

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Object Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series. Methods Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS). Results Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p < 0.001), and BPI by 79.9% ± 14.7% (p < 0.001). In the BPA group, after 12 months the mean VAS score improved by 52.7% ± 30.2% (p < 0.001), SF-36 by 15.6% ± 30.5% (p = 1.000), UWNPS by 26.2% ± 40.8% (p = 0.399), and BPI by 38.4% ± 41.7% (p = 0.018). Mean DBS parameters were 2.5 V, 213 microseconds, and 25 Hz. Conclusions Deep brain stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

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“…Similarly, milder pain is related by patients who underwent operative reconstruction of the BP, even by those in whom root avulsion was managed by the use of intercostal nerves as new sources of neurotization of the PN's of the upper extremity, and showed satisfactory motor and sensory return. Some authors regard pain as one of the major problems of patients with BP injuries [36]. Our experience up to now has shown that there is an inverse ratio between pain in the affected upper limb and functional restoration, occurring spontaneously or achieved by microsurgical repair.…”

Section: Personal Experiencementioning

confidence: 85%

Contemporary treatment of peripheral nerve and brachial plexus lesions

Dolenc

1986

Neurosurg. Rev.

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The paper outlines modern microsurgical techniques utilized in the repair of injured peripheral motor and sensory neurons. The diagnostic evaluation and its timing, which depend on the level and the extent of the lesion, are proposed. The author stresses the need during the operation for close monitoring, which is a prerequisite of proper coaptation of the severed nerve structures. A technically perfect microsurgical repair provides optimal conditions for regeneration of the divided peripheral nerves and/or brachial plexus. The repair of avulsion injuries of the brachial plexus still poses many technical problems; the author proposes the use of intercostal nerves as new sources for grafts. Pain, which is one of the major problems occurring with peripheral nerve injuries, especially with lesions to the brachial plexus, is not dealt with in detail. The author maintains that the contemporary treatment of peripheral nerve injuries as a rule yields good results, while this is not yet true of the management of brachial plexus lesions.

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Pain in Avulsion of the Brachial Plexus

Abstract: The author reviews the diagnosis and treatment of avulsion injuries of the brachial plexus. He discusses the nature of the pain and the use of transcutaneous nerve stimulation for its relief.

Cited by 66 publications

References 0 publications

Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Contemporary treatment of peripheral nerve and brachial plexus lesions

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