Treatment of neuropathic pain after peripheral nerve and brachial plexus traumatic injury

Lovaglio, Ana; Socolovsky, Mariano; Masi, Gilda Di; Bonilla, Gonzalo

doi:10.4103/0028-3886.250699

Cited by 40 publications

(31 citation statements)

References 11 publications

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“…[ 3 ] Several studies continue to demonstrate the increased efficacy of early SGB therapy. [ 1 , 4 ] A study from 2017 demonstrated that patients with established CRPS and a shorter duration of symptoms needed fewer SGBs to achieve >50% pain relief. [ 3 ] The majority of patients will require two blocks, between 1 and 3 weeks apart.…”

Section: Discussionmentioning

confidence: 99%

“…Preganglionic avulsion injuries can be surgically treated by neurotization, nerve transfers, traditional spinal (dorsal) column stimulation (SCS: 50% success), peripheral nerve stimulation, DREZ lesions, and in primary motor cortex stimulation (55% success rate) (MCS). [ 4 , 7 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] There are several different effective management strategies including nerve transfer surgery (73% recovery rate), microsurgery (50–75% in postganglionic avulsion), spinal cord stimulator use, dorsal root entry zone (DREZ) lesions, and SGBs which give 57% improvement with chronic regional pain syndrome (CRPS). [ 2 , 4 ] Here, we present a case where a patient with CRPS type II responded well to repeated SBGs.…”

Section: Introductionmentioning

confidence: 99%

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Management of CRPS secondary to preganglionic C8 nerve root avulsion: A case report and literature review

Ghaly

Haroutunian

Grigoryan

et al. 2020

Surgical Neurology International

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Background: Cervical nerve root avulsion is a well-documented result of high-velocity motor vehicle accidents (MVAs). In up to 21% of cases, preganglionic cervical root avulsion can result in a complex regional pain syndrome (CRPS) impacting the quality of life for patients already impaired by motor, sensory, and autonomic dysfunction. The optimal treatment strategies include repeated stellate ganglion blocks (SBGs). Case Description: A 43-year-old male sustained a high-velocity MVA resulting in the left C8 nerve root avulsion. This resulted in weakness in the C8 distribution, tactile allodynia, and dysesthesias. The magnetic resonance imaging demonstrated an abnormal signal ventral to the C8–T1 level. As the patient was not considered a candidate for surgical intervention secondary to the attendant brachial plexus injury, a C7–C8 epidural steroid injection was performed; this did not provide improvement. Before placing a spinal cord stimulator, the patient underwent a series of six ultrasound-guided SBGs performed 2 weeks apart; there was 75% improvement in pain and strength. Six years later, the patient continues to do well while receiving SBGs 4 times a year. Conclusion: A preganglionic cervical nerve root avulsion should not be a contraindication for a stellate ganglion block in a patient with established CRPS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of CRPS secondary to preganglionic C8 nerve root avulsion: A case report and literature review

Ghaly

Haroutunian

Grigoryan

et al. 2020

Surgical Neurology International

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show abstract

“…Transcutaneous nerve electrical stimulation (TENS) is commonly adopted to interfere with sensory perception and exerts an antalgic effect [81].…”

Section: Rehabilitationmentioning

confidence: 99%

Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions

Belviso

Palermi

Sacco

et al. 2020

JFMK

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The brachial plexus represents a complex anatomical structure in the upper limb. This “network” of peripheral nerves permits the rearrangement of motor efferent fibers, coming from different spinal nerves, in several terminal branches directed to upper limb muscles. Moreover, afferent information coming from different cutaneous regions in upper limb are sorted in different spinal nerves through the brachial plexus. Severe brachial plexus injuries are a rare clinical condition in the general population and in sport medicine, but with dramatic consequences on the motor and sensory functions of the upper limb. In some sports, like martial arts, milder injuries of the brachial plexus can occur, with transient symptoms and with a full recovery. Clinical evaluation represents the cornerstone in the assessment of the athletes with brachial plexus injuries. Electrodiagnostic studies and imaging techniques, like magnetic resonance and high-frequency ultrasound, could be useful to localize the lesion and to define an appropriate treatment and a functional prognosis. Several conservative and surgical techniques could be applied, and multidisciplinary rehabilitative programs could be performed to guide the athlete toward the recovery of the highest functional level, according to the type of injury.

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“…Neuropathic pain results from damage to the somatosensory system [24]. Microglia is an important neurological specific immune cell, influencing brain development, maintenance of the neural environment and response to nerve damage and repair.…”

Section: Introductionmentioning

confidence: 99%

Suppression of miR-155 attenuates neuropathic pain by inducing an M1 to M2 switch in microglia

Zhang¹,

Chen²,

Nai³

et al. 2020

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Introduction: The polarization state of microglia affects the progress of neuropathic pain. MiR-155 modulates polarization of microglia, while its role in neuropathic pain has not been well studied. Material and methods: We separately used lipopolysaccharide (LPS) and interleukin 4 (IL-4) for constructing an M1/M2 polarization model in BV-2 cells. The levels of CD86, iNOS, CD206, Arg and miR-155 were measured by western blot or qRT-PCR, as needed. Subsequently, BV-2 cells were transfected with miR-155 mimics or inhibitor to explore the effects of miR-155 on polarization states. We also constructed a neuropathic pain model by applying spinal nerve ligation (SNL) in Wistar rats with miR-155 agomir or antagomir injection. The withdrawal threshold was measured by Von Frey fibre needle. The levels of interleukin 1β (IL-1β), tumour necrosis factor α (TNF-α) and the proportion of M1-polarized microglia in primary microglia from rats were measured by ELISA and flow cytometry. Results: LPS induced M1 polarization in BV-2 cells with increasing of CD86, iNOS and miR-155, while IL-4 induced M2 polarization in BV-2 cells with increasing of CD206, Arg and decreasing of miR-155. MiR-155 mimics upregulated CD86 and downregulated CD206, whereas miR-155 inhibitor downregulated CD86 and upregulated CD206. MiR-155 antagomir increased the withdrawal threshold, decreased the production of IL-1β, TNF-α and the proportion of M1-polarized microglia in primary microglia. Conclusions: Results demonstrate that suppression of miR-155 attenuates neuropathic pain by inducing an M1 to M2 switch in microglia. Our findings provide a new perspective to understand the function of miR-155 in microglia.

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Treatment of neuropathic pain after peripheral nerve and brachial plexus traumatic injury

Cited by 40 publications

References 11 publications

Management of CRPS secondary to preganglionic C8 nerve root avulsion: A case report and literature review

Management of CRPS secondary to preganglionic C8 nerve root avulsion: A case report and literature review

Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions

Suppression of miR-155 attenuates neuropathic pain by inducing an M1 to M2 switch in microglia

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