Department of Anesthesiology, Aarhus University Hospital, University of Aarhus, Denmark.
Clin J Pain. 2010 Nov-Dec;26(9):788-93. doi: 10.1097/ajp.0b013e3181ed0823.
Injury to peripheral nerves associated with trauma, amputation, or surgery may lead to the formation of neuromas that can produce severe pain refractory to pharmacotherapy. Ectopic impulse activity arising in blindly ending axons within the neuroma, which contain abnormal accumulations of sodium channels, is thought to be a major contributor to this pain. The effect of surgical excision has remained controversial. Here we report a prospective study on the effect of neuroma removal on pain.
A series of 6 patients with chronic neuropathic pain owing to neuromas after nerve injury were studied before and 3 months after neuroma excision. Quantitative sensory testing included measurement of areas of brush-evoked allodynia, pinprick hyperalgesia, and mechanical and thermal thresholds. The hypothesis that the analgesic response to a preoperative, intravenous infusion of the sodium channel blocker lidocaine can predict outcome of surgery was also tested.
Surgery only relieved spontaneous pain in 2 out of the 6 patients. One of those patients had a prior poor response to neuroma removal. In one patient the pain worsened. Response to surgical removal of neuromas was not predicted by the response to preoperative infusion of intravenous lidocaine.
Our findings suggest that, as a therapeutic maneuver, surgical excision of neuromas should be reserved for only those patients with intractable pain, who have failed to respond to other therapies. However, prior poor response to neuroma removal does not preclude relief of pain after a new excision.
创伤、截肢或手术引起的周围神经损伤可导致神经瘤形成，从而产生对药物治疗有抗性的剧烈疼痛。在神经瘤内无末梢轴突内产生的异位冲动活动被认为是这种疼痛的主要原因，其内含有异常积聚的钠离子通道。手术切除的效果一直存在争议。在此，我们报告了一项关于神经瘤切除对疼痛影响的前瞻性研究。
对 6 例因神经损伤后神经瘤引起的慢性神经性疼痛患者进行研究，在神经瘤切除前和切除后 3 个月进行研究。定量感觉测试包括测量毛刷诱发的触诱发痛、刺痛痛觉过敏和机械及热阈值的区域。还测试了静脉内给予钠离子通道阻滞剂利多卡因的术前镇痛反应是否可以预测手术结果的假设。
手术仅缓解了 6 例患者中的 2 例自发性疼痛。其中 1 例患者先前对神经瘤切除反应不佳。在 1 例患者中，疼痛恶化。对神经瘤切除术的反应不能通过术前静脉内利多卡因输注的反应来预测。
我们的发现表明，作为一种治疗手段，神经瘤切除术应仅保留给那些对其他治疗方法无反应的顽固性疼痛患者。然而，先前对神经瘤切除反应不佳并不能排除新切除后疼痛缓解的可能性。
