Department of Neurosurgery, Central Military Hospital, Buenos Aires, Argentina.
Acta Neurochir (Wien). 2011 Jan;153(1):171-6. doi: 10.1007/s00701-010-0709-3. Epub 2010 Jun 13.
Peripheral nerve lesions usually are associated with neuropathic pain. In the present paper, we describe a simple scale to quantify pain after brachial plexus injuries and apply this scale to a series of patients to determine initial outcomes after reconstructive surgery.
Fifty-one patients with traumatic brachial plexus avulsion injuries were treated over the period of one calendar year at one center by the same surgical team. Of these, 28 patients who were available for follow-up reported some degree of neuropathic pain radiating towards the hand or forearm and underwent reconstructive microsurgery and direct pain management, including trunk and nerve neurolysis and repair. A special pain severity rating scale was developed and used to assess patients' pain before and after surgery, over a minimum follow-up of 6 months. An independent researcher, not part of the surgical team, performed all pre- and postoperative evaluations.
Of the 28 patients with brachial plexus traction injuries who met eligibility criteria, 93% were male, and most were young (mean age, 27.6 years). The mean preoperative severity of pain using our scale was 30.9 out of a maximum of 37 (± 0.76 SD), which fell to a mean of 6.9 (± 0.68 SD) 6 months post-procedure. On average, pain declined by 78% across the whole series, a decline that was statistically significant (p < .001). Subset analysis revealed similar improvements across all the different parameters of pain.
We have designed and tested a simple and reliable method by which to quantify neuropathic pain after traumatic brachial plexus injuries. Initial surgical treatment of the paralysis--including nerve, trunk and root reconstruction, and neurolysis--comprises an effective means by which to initially treat neuropathic pain. Ablative or neuromodulative procedures, like dorsal root entry zone, should be reserved for refractory cases.
周围神经病变通常与神经病理性疼痛有关。在本文中，我们描述了一种简单的量表来量化臂丛神经损伤后的疼痛，并将该量表应用于一系列患者，以确定重建手术后的初步结果。
在一个日历年内，同一手术团队在一个中心治疗了 51 例创伤性臂丛神经撕脱伤患者。其中，28 例随访患者报告有一定程度的向手部或前臂放射的神经病理性疼痛，并接受了重建显微手术和直接疼痛管理，包括干和神经神经松解和修复。开发了一种特殊的疼痛严重程度评分量表，用于评估患者手术前后的疼痛，随访时间至少为 6 个月。一名独立的研究人员（不属于手术团队）进行了所有术前和术后评估。
在符合入选标准的 28 例臂丛神经牵引损伤患者中，93%为男性，且大多数为年轻人（平均年龄 27.6 岁）。使用我们的量表，术前疼痛严重程度的平均值为 30.9（满分 37，±0.76SD），术后 6 个月降至 6.9（±0.68SD）。平均而言，整个系列的疼痛下降了 78%，这具有统计学意义（p<0.001）。亚组分析显示，所有疼痛参数都有相似的改善。
我们已经设计并测试了一种简单可靠的方法，用于量化创伤性臂丛神经损伤后的神经病理性疼痛。初始的麻痹治疗——包括神经、干和根重建以及神经松解——构成了治疗神经病理性疼痛的有效手段。消融或神经调节程序，如背根入口区，应保留用于难治性病例。
