Guo Jinding, Gao Kaiming, Zhou Yingjie, Zhao Xin, Lao Jie
Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
Clin Neurol Neurosurg. 2020 Apr;191:105692. doi: 10.1016/j.clineuro.2020.105692. Epub 2020 Jan 23.
The goal of this study was to compare clinical characteristics of neuropathic pain associated with total brachial plexus injury before and after surgeries and to correlate possible contributing factors concerning to the pain prognosis.
Thirty patients with both total brachial plexus injury and neuropathic pain were included. Neuropathic pain was evaluated in terms of pain intensities, symptoms and regions. Pain intensities were evaluated by a visual analogue scale. The Neuropathic Pain Symptoms Inventory questionnaire and body maps were used to compare the pain symptoms and regions. Demographic data, injury and repair information were evaluated to analyze the possible factors influencing the prognosis.
The average pain score of all participants was 7.13 ± 2.46 preoperatively and 5.40 ± 2.08 postoperatively. All patients were divided into Pain Relief Group and Pain Aggravation Group. Older age (p = 0.042), machine traction injury (p = 0.019)and nerve transplantation(p = 0.015) seemed to be related with pain aggravation. Paroxysmal pain was aggravated after surgical repairs (p = 0.041), while paresthesia/dysesthesia improved after surgery (p = 0.003). The permanent component of the pain (spontaneous pain) did not show any significant change (p = 0.584). Pain in C5 (p < 0.001) and C6 (p = 0.031) dermatomes got relieved after surgery.
This study revealed the neuropathic pain of most patients with total brachial plexus injury was alleviated after neurosurgery, and the pain prognosis of different symptoms and regions varied after the nerve repair.
本研究旨在比较全臂丛神经损伤相关神经性疼痛在手术前后的临床特征，并关联与疼痛预后相关的可能影响因素。
纳入30例全臂丛神经损伤且伴有神经性疼痛的患者。从疼痛强度、症状及区域方面对神经性疼痛进行评估。采用视觉模拟量表评估疼痛强度。使用神经性疼痛症状量表问卷及人体图来比较疼痛症状和区域。评估人口统计学数据、损伤及修复信息，以分析可能影响预后的因素。
所有参与者术前平均疼痛评分为7.13±2.46，术后为5.40±2.08。所有患者被分为疼痛缓解组和疼痛加重组。年龄较大（p = 0.042）、机器牵引伤（p = 0.019）和神经移植（p = 0.015）似乎与疼痛加重有关。手术修复后阵发性疼痛加重（p = 0.041），而感觉异常/感觉迟钝在术后有所改善（p = 0.003）。疼痛的永久性成分（自发痛）未显示出任何显著变化（p = 0.584）。C5（p < 0.001）和C6（p = 0.031）皮节的疼痛在术后得到缓解。
本研究表明，大多数全臂丛神经损伤患者的神经性疼痛在神经外科手术后得到缓解，神经修复后不同症状和区域的疼痛预后有所不同。
