Pain Relief From Preganglionic Injury to the Brachial Plexus by Late Intercostal Nerve Transfer

Berman, J.; Chen, L.; Taggart, Melissa W.; Birch, Rolfe

doi:10.1302/0301-620x.78b5.0780759

Cited by 50 publications

(27 citation statements)

References 8 publications

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“…This is a strong argument in favour of their policy for rehabilitation. Berman et al (1996) found that pain was relieved by late intercostal transfer in 16 of their 19 patients; their study confirmed earlier impressions that successful re-innervation often relieves pain (Fig. 1).…”

Section: Rupture or Avulsion C5 To C6 (C7) With An Intact (C7) C8supporting

confidence: 78%

Brachial Plexus Injuries

Birch

1996

The Journal of Bone and Joint Surgery. British volume

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Section: Rupture or Avulsion C5 To C6 (C7) With An Intact (C7) C8supporting

confidence: 78%

Brachial Plexus Injuries

Birch

1996

The Journal of Bone and Joint Surgery. British volume

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“…While pain questionnaires and rating scales (verbal and numeric) can assess the intensity, quality, and frequency of pain and are often used in the surgical literature, [105][106][107][108][109][110][111][112][113][114][115][116][117][118][119][120] these types of measures do not evaluate the psychosocial factors that are often associated with neuropathic pain. The European Federation of Neurological Societies has presented guidelines for the assessment of neuropathic pain; 1 a baseline assessment can be achieved with NRS, VRS, or VAS, and more in-depth assessment can include pain descriptors, temporal factors, and functional impact.…”

Section: Contextual (Psychosocial) Factorsmentioning

confidence: 99%

Neuropathic Pain in Patients with Upper-Extremity Nerve Injury

Novak

Katz²

2010

Physiotherapy Canada

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Purpose: The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upperextremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients. Summary of Key Points: A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury. Recommendation: To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning.Key Words: literature review, nerve injury, neuropathic pain, outcome Novak CB, Katz J. Neuropathic pain in patients with upper-extremity nerve injury. Physiother Can. 2010;62:190-201. RÉ SUMÉObjectif : L'objectif de cette revue é tait de pré senter une analyse de la documentation portant sur les é tudes ré pertorié es concernant les patients aux prises avec des lé sions nerveuses traumatiques des membres supé rieurs (excluant l'amputation), d'é valuer la pré sence d'un lien entre la douleur né vropathique et les ré sultats attendus chez les patients à la suite de lé sions nerveuses traumatiques des membres supé rieurs et de formuler des recommandations en vue d'inclure le recours à des mesures de rendement plus complè tes par les cliniciens traitant ces patients. Ré sumé des principales é tapes : Une recherche documentaire dans Medline et dans CINAHL a permis de ré pertorier 48 articles. Cette recherche a permis de constater que parmi les patients souffrant de lé sions nerveuses pé riphé riques é tudié s, trè s peu avaient signalé des douleurs né vropathiques. Lorsque de la douleur é tait signalé e, des é chelles de mesure numé riques ou des é chelles visuelles analogues é taient utilisé es le plus fré quemment et l'on faisait rarement appel à des questionnaires normalisé s pour é valuer la douleur ou la fonction psychosociale. Des faits ré cents dé montrent qu'à la suite d'une lé sion nerveuse pé riphé rique, de nombreux patients ressentent de la douleur et souffrent d'une incapacité à long terme. Recommandation : Pour mieux comprendre la douleur né vropathique qui survient à la suite d'une lé sion nerveuse pé riphé rique, les prochaines é tudes devraient inclure des mesures valables et fiables des dé ficiences physiques, de la douleur, des incapacité s, de la qualité de vie lié e à la santé et à la fonctio...

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“…In almost 80 % of patients with complete brachial plexus palsy, at least one root is not avulsed [6,7]. Hence, it is believed that brachial plexus pain is not generated by avulsed roots, but rather by non-avulsed roots.…”

Section: Introductionmentioning

confidence: 99%

Expression of activating transcription factor 3 (ATF3) in uninjured dorsal root ganglion neurons in a lower trunk avulsion pain model in rats

et al. 2013

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Purpose Clinically, neuropathic pain is frequent and intense following brachial plexus injury. It is thought that brachial plexus pain is not generated by avulsed roots, but rather by non-avulsed roots, since the avulsed root could not possibly transmit action potentials to central nerves. The aim of this study was to evaluate pain behavior and activation of sensory neurons in a brachial plexus avulsion (BPA) model in rats. Methods Fifteen male Wistar rats were used. In the BPA group, the C8-T1 roots were avulsed from the spinal cord with forceps at the lower trunk level (n = 5). In the naïve group, rats did not receive any procedures (n = 5). In the sham-operated group, the lower trunk was simply exposed (n = 5). Mechanical hyperalgesia of forelimbs corresponding to C6 and C7 dermatomes was measured using von Frey filaments every third day for 3 weeks. Activation of DRG neurons was immunohistochemically examined using anti-ATF3 (a marker for neuron activation) antibodies 21 days after surgery. Von Frey and immunohistochemical data between groups were analyzed using a Kruskal-Wallis test, followed by Mann-Whitney U tests. Bonferroni corrections were performed. Results Animals in the BPA group displayed significant mechanical hyperalgesia at the dermatome innervated by uninjured nerves continuing through day 21 compared with animals in the sham-operated group. ATF3-immunoreactive small and large DRG neurons were significantly activated in the BPA group (10.6 ± 9.5 and 5.2 ± 4.1 %, 39.7 ± 6.7 and 25.2 ± 10.3 %, 78.0 ± 9.1 and 53.7 ± 29.3 %) compared with the sham-operated group (0.7 ± 0.9 and 0 ± 0 %, 2.8 ± 2.0 and 1.0 ± 2.0 %, 3.9 ± 2.7 and 8.6 ± 10.1 %) at every level of C5, 6, and 7. In the naïve group, no DRG neurons were activated. ATF3-immunoreactive small and large DRG neurons were significantly activated at the level of C7 compared with C6 and C5, and significantly activated at the level of C6 compared with C5 in the BPA group. Conclusions Expression of ATF3 in uninjured DRG neurons may contribute to pain following brachial plexus avulsion injury. Consequently, spared spinal sensory nerves may represent therapeutic targets for treatment of this pain.

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Pain Relief From Preganglionic Injury to the Brachial Plexus by Late Intercostal Nerve Transfer

Abstract: W e performed intercostal nerve transfer in 19patients to relieve pain from preganglionic injury to the brachial plexus. The procedure was successful in 16 patients at a mean of 28.6 months (12 to 68) after the injury.

Cited by 50 publications

References 8 publications

Brachial Plexus Injuries

Brachial Plexus Injuries

Neuropathic Pain in Patients with Upper-Extremity Nerve Injury

Expression of activating transcription factor 3 (ATF3) in uninjured dorsal root ganglion neurons in a lower trunk avulsion pain model in rats

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