Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

Stevanato, Giorgio; Devigili, Grazia; Eleopra, Roberto; Fontana, Pietro; Lettieri, Christian; Baracco, Chiara; Guida, Franco; Rinaldo, Sara; Bevilacqua, Marzio

doi:10.1007/s10143-014-0523-0

Cited by 40 publications

(32 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were no reports of neurological injury. Stevanato et al recently reported an enhanced implantation technique for patients with post‐traumatic brachial plexus injury or distal peripheral nerve lesions with chronic severe intractable neuropathic pain . The authors report that by implanting quadripolar leads proximal to the site of injury and close to the axilla, there was no lead migration or any other complication at 12‐month follow‐up in all seven patients studied.…”

Section: Causation and Reduction Of Neurological Complicationsmentioning

confidence: 94%

The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury

Deer¹,

Lamer

Pope³

et al. 2017

Neuromodulation: Technology at the Neural Interface

109

View full text Add to dashboard Cite

Section: Causation and Reduction Of Neurological Complicationsmentioning

confidence: 94%

The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury

Deer¹,

Lamer

Pope³

et al. 2017

Neuromodulation: Technology at the Neural Interface

109

View full text Add to dashboard Cite

“…Peripheral nerve stimulation provides 50-83% pain relief in 65-80% of the patients [116][117][118][119][120], and the affected limb preserves the residual function remaining after the injury [121]. Allodynia and neuropathic pain are controlled with mild improvement in the sensory function [116,118].…”

Section: Neuromodulation Proceduresmentioning

confidence: 99%

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Saiz-Sapena¹,

Vanaclocha‐Vanaclocha²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

View full text Add to dashboard Cite

Brachial plexus injuries are commonly followed by chronic pain, mostly with neuropathic characteristics. This is due to peripheral nerve lesions, particularly nerve root avulsions, as well as upper limb amputations, and complex regional pain syndrome (CRPS). The differential diagnosis between CRPS and neuropathic pain is essential as the treatment is different for each of them. Medical treatments are the first step, but for refractory cases there are two main types of surgical alternatives: ablative techniques and neuromodulation. The first group involves destruction of the posterior horn deafferented neurons and usually provides a better pain control but has a 10% complication rate. The second group provides pain control with function preservation but with limited effectiveness. Each case has to be thoroughly evaluated to apply the treatment modality best suited for it. due to iatrogenia [8][9][10][11][12][13][14][15][16], particularly during lymph node biopsy [17, 18] or treatment of some malignancies [19]. The pain is chronic [20], persistent [7], constant [21], burning [22] and throbbing [17], with paroxysmal discharges [3, 6, 23], particularly upon gentle rubbing the affected area [4].The pain is distributed in the distal areas of the upper limb, covering several dermatomes, mostly the caudal ones [24] and particularly the hand [5, 17, 23, 25]. The paroxysmal pain is felt in the arm [26]. Allodynia, hypersensitivity and electric-like discharges are present at the border between the normal and affected dermatomes [17,[26][27][28][29], particularly between T 1 and T 2 at the posterior aspect of the elbow [26].The pain severity correlates with the magnitude of the brachial plexus injury [2,3] and to the number of avulsed nerve roots [2-4, 21, 26, 30-33], particularly when the lower roots are affected [24,34,35]. Nevertheless, Bertelli et al. [21] found that in isolated C 8 and T 1 nerve root avulsions, there was no pain at all.The pain does not appear immediately after the injury but a few days later [24] and no longer than 3 months after it [5, 6, 24, 26,35,36].The neuropathic pain can be associated with phantom [37] or stump pain [38] in case of upper limb amputation, or to complex regional pain syndrome (CRPS) [6], inducing a complex pain condition rather difficult to control [19,30,31].Self-mutilation has been described in 5-29% of obstetric brachial plexus injury cases [39,40].The quality of life is seriously impaired with sleep disorders, family troubles, unemployment, chronic depression and social withdrawal [2, 5, 6, 17, 21,[41][42][43][44]. Additionally, the chronic pain is a further hindrance to comply with a good rehabilitation programme, impairing a possible functional recovery [6,45,46]. Among all the disabilities induced by the brachial plexus injury, the pain has been found to be the symptom that most negatively affects the quality of life [47].Treatment of this chronic pain can be troublesome, as the response to the different treatment modalities is poor and not all of them allow preservatio...

show abstract

“…In a recent study, Stevanato implanted surgically paddle leads in the axillary cavity in seven patients suffering from chronic post‐traumatic neuropathic pain of BP and upper limb. All the patients reported a pain relief ≥50%, with a mean pain severity improving from nine before surgery to 2.6 at the 12‐month follow‐up . In 2002, Goroszeniuk was the first to implant percutaneously a PNS cylindrical lead in the BP with good results .…”

Section: Discussionmentioning

confidence: 99%

“…Among neuromodulation techniques, both cervical spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been proposed (1,2). Since its first description by Wall and Sweet in 1967 (3), PNS efficacy for chronic neuropathic pain of the upper limbs has been suggested in few isolated cases or short pioneering series reporting variable but encouraging results (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). A combination of peripheral and central mechanisms might explain the analgesic effect induced by low-frequency PNS which preferentially excites large myelinated fibers: modulation of peripheral nociceptors (16), blockade of afferent nociceptive inputs by continuous stimulation (6), modulation of nociception in the dorsal horn of the spinal cord (17).…”

Section: Introductionmentioning

confidence: 99%

Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra-Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb

Bouche¹,

Manfiotto

Rigoard

et al. 2017

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

Cited by 40 publications

References 31 publications

The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury

The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra-Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb

Contact Info

Product

Resources

About