The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler, Louis H.; Mackinnon, Susan E.

doi:10.1007/s13311-018-00695-z

Cited by 27 publications

(39 citation statements)

References 87 publications

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“…It is thought that minimally invasive techniques do not offer adequate visibility needed to engage all causative abnormalities within the distorted anatomical space. 63 Furthermore, Lusskin et al advised of the potential risk of nerve devascularization during neurolysis. 55 Wide exposure may help protect the nerve and prevent surgical revision(s).…”

Section: Discussionmentioning

confidence: 99%

Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Morgan

Elliot

Banala

et al. 2020

J Brachial Plex Peripher Nerve Inj

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Background Brachial plexopathy causes pain and loss of function in the affected extremity. Entrapment of the brachial plexus terminal branches within the surrounding connective tissue, or medial brachial fascial compartment, may manifest in debilitating symptoms. Open fasciotomy and external neurolysis of the neurovascular bundle in the medial brachial fascial compartment were performed as a surgical treatment for pain and functional decline in the upper extremity. The aim of this study was to evaluate pain outcomes after surgery in patients diagnosed with brachial plexopathy. Methods We identified 21 patients who met inclusion criteria. Documents dated between 2005 and 2019 were reviewed from electronic medical records. Chart review was conducted to collect data on visual analog scale (VAS) for pain, Semmes-Weinstein monofilament test (SWMT), and Medical Research Council (MRC) scale for muscle strength. Pre- and postoperative data was obtained. A paired sample t-test was used to determine statistical significance of pain outcomes. Results Pain severity in the affected arm was significantly reduced after surgery (pre: 6.4 ± 2.5; post: 2.0 ± 2.5; p < 0.01). Additionally, there was an increased response to SWMT after the procedure. More patients achieved an MRC rating score ≥3 and ≥4 in elbow flexion after surgery. This may be indicative of improved sensory and motor function. Conclusion Open fasciotomy and external neurolysis at the medial brachial fascial compartment is an effective treatment for pain when nerve continuity is preserved. These benefits were evident in patients with a prolonged duration elapsed since injury onset.

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Section: Discussionmentioning

confidence: 99%

Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Morgan

Elliot

Banala

et al. 2020

J Brachial Plex Peripher Nerve Inj

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“…Neuromas usually develop following trauma or surgery and effect 2% to 60% of patients with nerve injury. 15 Why some patients develop painful neuromas and others do not is incompletely understood. 15 Often, patients will present with a history of pain for which they had surgery, and that pain resolved but was replaced with much worse pain after surgery.…”

Section: Discussionmentioning

confidence: 99%

Neurocap Use for the Treatment of Iatrogenic Neuropathic Pain: Preliminary Operative Results in 3 Patients

Thomeer

Tijink

et al. 2020

Ear Nose Throat J

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Painful neuromas are a devastating condition that is notoriously difficult to treat. The large number of techniques that have been attempted suggest that no one technique is superior. Neuromas often occur in the extremities, but iatrogenically caused pain in the head and neck area has also been described. This article describes 3 consecutive patients diagnosed with traumatic neuroma who underwent transection of the causative nerve, followed by capping of the nerve stump with a Neurocap. With a follow-up of 7 to 24 months, our results show a marked reduction in the pain scores of all 3 patients. The preliminary results indicate that this technique might be a viable treatment option for patients with a suspected neuroma in the head and neck area.

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“…The anaesthetists have taken over [50] and provided a large selection of minimally invasive techniques and revolutionised the percutaneous and oral management of chronic pain [51]. The surgical techniques of pain management have been slowly obliterated [52] in favour of those that involve peripheral or central nervous system stimulation [53,54] and intrathecal or epidural drug administration [55][56][57]. In posterior spinal cord stimulation procedures, it has been proven that the surgically implanted pad electrodes provide better results than the needle-inserted ones [58].…”

Section: Current Situationmentioning

confidence: 99%

“…Over the years many neurosurgeons have lost interest in the chronic pain treatment and retreated from the pain clinics [49]. We need to change this trend and get more involved in this area [52], so that our capabilities can be requested when they could be of particular help, benefitting patients which lack viable alternatives. This book is a plea to awaken physicians in some ablative procedures that should have never been forgotten.…”

Section: Situation In Each Hospitalmentioning

confidence: 99%

Where We Come From and Are We Aware of Where We Are Going To?

Vanaclocha¹,

Saiz-Sapena²,

Ortiz-Criado³

et al. 2021

Chronic Pain - Physiopathology and Treatment

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Chronic pain is a pathological condition that requests specific medical attention. Its treatment has been imperative since the origin of our species, taking advantage of herbs and natural remedies available in the primitive environment. Morphine has stood the test of time as has been continuously used for the past 8 millennia. The anatomical knowledge of the nociceptive sensation pathways led to the introduction of some surgical techniques directed to stop this pain transmission. Due to their aggressiveness and to the fact that they are irreversible, these techniques were soon replaced by neurostimulation procedures. Being reversible and allowing a change in stimulation parameters soon became the preferred treatment strategy. Over the years a small subset of patients continues to suffer from chronic pain refractory to the usual neurostimulation and pain-controlling medications. These patients can perhaps benefit from one of the surgical ablative procedures. Some of these techniques have been proven particularly effective throughout the years. For some limited income patients in underdeveloped countries, these techniques may be their only accessible option. Doctors have to keep in mind these surgical techniques to put them at the service of our patients in the very few cases in which they are needed. Letting these ablative techniques to die in oblivion would be a disservice to our patients.

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The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Cited by 27 publications

References 87 publications

Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Neurocap Use for the Treatment of Iatrogenic Neuropathic Pain: Preliminary Operative Results in 3 Patients

Where We Come From and Are We Aware of Where We Are Going To?

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