Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report

Chikama, Yoji; Maeda, Aiko; Tanaka, Ryudo; Tominaga, Masachika; Shirozu, Kazuhiro; Yamaura, Ken

doi:10.1186/s40981-022-00574-9

Cited by 1 publication

(2 citation statements)

References 16 publications

(21 reference statements)

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“…124–126 For phantom limb pain, both placebo-controlled and uncontrolled studies support peripheral nerve blocks and cryoablation, 127,128 while for brachial plexus avulsion the evidence for selective nerve root blocks is anecdotal, and in some cases may involve anesthetization of nonavulsed nerve roots. 129…”

Section: Epidemiology and Clinical Presentationmentioning

confidence: 99%

“…[124][125][126] For phantom limb pain, both placebo-controlled and uncontrolled studies support peripheral nerve blocks and cryoablation, 127,128 while for brachial plexus avulsion the evidence for selective nerve root blocks is anecdotal, and in some cases may involve anesthetization of nonavulsed nerve roots. 129 treatment This section provides an overview of treatments for the most widely accepted conditions associated with deafferentation pain, with readers referred to other sources for more controversial conditions such as multiple sclerosis and peripheral neuropathies. 11,130,131 The treatments in this section focus on pharmacotherapy and noninvasive modalities, with results of systematic reviews, and surgical and integrative therapies shown in tables 3 and 4, while table 5 represents a summary of evidence.…”

Section: Pain In the Context Of Sensory Deafferentationmentioning

confidence: 99%

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Pain in the Context of Sensory Deafferentation

Cohen,

Caterina,

Yang

et al. 2024

Anesthesiology

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Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.

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