Caragher Seamus P, Khouri Kimberly S, Raasveld Floris V, Winograd Jonathan M, Valerio Ian L, Gfrerer Lisa, Eberlin Kyle R
From the Harvard Medical School, Boston, Mass.
Division of Plastic and Reconstructive Surgery, Massachusetts General Hosptial, Boston, Mass.
Plast Reconstr Surg Glob Open. 2023 May 19;11(5):e5005. doi: 10.1097/GOX.0000000000005005. eCollection 2023 May.
Neuropathic pain (NP) underlies significant morbidity and disability worldwide. Although pharmacologic and functional therapies attempt to address this issue, they remain incompletely effective for many patients. Peripheral nerve surgeons have a range of techniques for intervening on NP. The aim of this review is to enable practitioners to identify patients with NP who might benefit from surgical intervention. The workup for NP includes patient history and specific physical examination maneuvers, as well as imaging and diagnostic nerve blocks. Once diagnosed, there is a range of options surgeons can utilize based on specific causes of NP. These techniques include nerve decompression, nerve reconstruction, nerve ablative techniques, and implantable nerve-modulating devices. In addition, there is an emerging role for preoperative involvement of peripheral nerve surgeons for cases known to carry a high risk of inducing postoperative NP. Lastly, we describe the ongoing work that will enable surgeons to expand their armamentarium to better serve patients with NP.
神经性疼痛（NP）在全球范围内导致了严重的发病率和残疾。尽管药物治疗和功能治疗试图解决这个问题，但对许多患者来说仍然效果不完全理想。外周神经外科医生有一系列用于干预NP的技术。本综述的目的是使从业者能够识别可能从手术干预中受益的NP患者。NP的检查包括患者病史、特定的体格检查手法，以及影像学检查和诊断性神经阻滞。一旦确诊，外科医生可以根据NP的具体病因采用一系列选择。这些技术包括神经减压、神经重建、神经消融技术和植入式神经调节装置。此外，对于已知有诱发术后NP高风险的病例，外周神经外科医生术前参与治疗的作用正在显现。最后，我们描述了正在进行的工作，这将使外科医生能够扩充他们的医疗手段，以更好地为NP患者服务。
