Prevalence of post-traumatic neuropathic pain after digital nerve repair and finger amputation

Lange, J; Duraku, Liron S.; Power, Dominic; Rajaratnam, Vaikunthan; Selles, Ruud W.; Huygen, Frank; Hundepool, Caroline A.; Zuidam, J. Michiel

doi:10.1016/j.bjps.2022.06.033

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…Following PNI, there exists a certain degree of inherent capacity for repair and regeneration, but recovering from severe nerve injuries can still be difficult, and the results achieved thus far have not been entirely satisfactory [33][34][35]. Additionally, for important nerve defects, a nerve autograft is the gold standard, but it has limitations such as donor site morbidity, a limited supply of donor nerves, and a lack of size congruence [36,37].…”

Section: Discussionmentioning

confidence: 99%

Application of Adipose Stem Cells in 3D Nerve Guidance Conduit Prevents Muscle Atrophy and Improves Distal Muscle Compliance in a Peripheral Nerve Regeneration Model

Trâmbițaș,

Cordoș,

Dorobanțu

et al. 2024

Bioengineering

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Background: Peripheral nerve injuries (PNIs) represent a significant clinical problem, and standard approaches to nerve repair have limitations. Recent breakthroughs in 3D printing and stem cell technologies offer a promising solution for nerve regeneration. The main purpose of this study was to examine the biomechanical characteristics in muscle tissue distal to a nerve defect in a murine model of peripheral nerve regeneration from physiological stress to failure. Methods: In this experimental study, we enrolled 18 Wistar rats in which we created a 10 mm sciatic nerve defect. Furthermore, we divided them into three groups as follows: in Group 1, we used 3D nerve guidance conduits (NGCs) and adipose stem cells (ASCs) in seven rats; in Group 2, we used only 3D NGCs for seven rats; and in Group 3, we created only the defect in four rats. We monitored the degree of atrophy at 4, 8, and 12 weeks by measuring the diameter of the tibialis anterior (TA) muscle. At the end of 12 weeks, we took the TA muscle and analyzed it uniaxially at 10% stretch until failure. Results: In the group of animals with 3D NGCs and ASCs, we recorded the lowest degree of atrophy at 4 weeks, 8 weeks, and 12 weeks after nerve reconstruction. At 10% stretch, the control group had the highest Cauchy stress values compared to the 3D NGC group (0.164 MPa vs. 0.141 MPa, p = 0.007) and the 3D NGC + ASC group (0.164 MPa vs. 0.123 MPa, p = 0.007). In addition, we found that the control group (1.763 MPa) had the highest TA muscle stiffness, followed by the 3D NGC group (1.412 MPa), with the best muscle elasticity showing in the group in which we used 3D NGC + ASC (1.147 MPa). At failure, TA muscle samples from the 3D NGC + ASC group demonstrated better compliance and a higher degree of elasticity compared to the other two groups (p = 0.002 and p = 0.008). Conclusions: Our study demonstrates that the combination of 3D NGC and ASC increases the process of nerve regeneration and significantly improves the compliance and mechanical characteristics of muscle tissue distal to the injury site in a PNI murine model.

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Section: Discussionmentioning

confidence: 99%

Application of Adipose Stem Cells in 3D Nerve Guidance Conduit Prevents Muscle Atrophy and Improves Distal Muscle Compliance in a Peripheral Nerve Regeneration Model

Trâmbițaș,

Cordoș,

Dorobanțu

et al. 2024

Bioengineering

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“…Surgery after nerve injuries, such as digital nerves, should not be delayed since it may have a severe impact on the patient’s quality of life 8 , impaired sensory function 30 , and with a risk of postoperative neuropathic pain 31 . In addition, pure motor nerve injuries may not cause residual problems, such as pain, or paraesthesia/tingling, but remaining problems, despite surgery, are often related to weakness in the affected hand and arm 32 , 33 .…”

Section: Discussionmentioning

confidence: 99%

Patient reported symptoms and disabilities before and after neuroma surgery: a register-based study

Dahlin,

Zimmerman,

Nyman

2023

Sci Rep

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Residual problems may occur from neuroma despite surgery. In a 12-month follow-up study using national register data, symptoms, and disabilities related to surgical methods and sex were evaluated in patients surgically treated for a neuroma. Among 196 identified patients (55% men; lower age; preoperative response rate 20%), neurolysis for nerve tethering/scar formation was the most used surgical method (41%; more frequent in women) irrespective of affected nerve. Similar preoperative symptoms were seen in patients, where different surgical methods were performed. Pain on load was the dominating symptom preoperatively. Women scored higher preoperatively at pain on motion without load, weakness and QuickDASH. Pain on load and numbness/tingling in fingers transiently improved. The ability to perform daily activities was better after nerve repair/reconstruction/transposition than after neurolysis. Regression analysis, adjusted for age, sex, and affected nerve, showed no association between surgical method and pain on load, tingling/numbness in fingers, or ability to perform daily activities. Neuroma, despite surgery, causes residual problems, affecting daily life. Choice of surgical method is not strongly related to pre- or postoperative symptoms. Neurolysis has similar outcome as other surgical methods. Women have more preoperative symptoms and disabilities than men. Future research would benefit from a neuroma-specific ICD-code, leading to a more precise identification of patients.

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“…42 Despite advances in surgical techniques, the incidence of chronic and neuropathic pain remains high. 24 In 1943, Herbert Seddon produced the first clinical classification of nerve injuries, 76 which was later refined by Sidney Sunderland. 82 A neurapraxic (transient) injury is accompanied by local myelin damage, but axons otherwise remain intact.…”

Section: Introductionmentioning

confidence: 99%

“…42 Despite advances in surgical techniques, the incidence of chronic and neuropathic pain remains high. 24…”

Section: Introductionmentioning

confidence: 99%

Long-term tactile hypersensitivity after nerve crush injury in mice is characterized by the persistence of intact sensory axons

Kim

Shim

Zhao

et al. 2023

Pain

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Traumatic peripheral nerve injuries are at high risk of neuropathic pain for which novel effective therapies are urgently needed. Preclinical models of neuropathic pain typically involve irreversible ligation and/or nerve transection (neurotmesis). However, translation of findings to the clinic has so far been unsuccessful, raising questions on injury model validity and clinically relevance. Traumatic nerve injuries seen in the clinic commonly result in axonotmesis (ie, crush), yet the neuropathic phenotype of “painful” nerve crush injuries remains poorly understood. We report the neuropathology and sensory symptoms of a focal nerve crush injury using custom-modified hemostats resulting in either complete (“full”) or incomplete (“partial”) axonotmesis in adult mice. Assays of thermal and mechanically evoked pain-like behavior were paralleled by transmission electron microscopy, immunohistochemistry, and anatomical tracing of the peripheral nerve. In both crush models, motor function was equally affected early after injury; by contrast, partial crush of the nerve resulted in the early return of pinprick sensitivity, followed by a transient thermal and chronic tactile hypersensitivity of the affected hind paw, which was not observed after a full crush injury. The partially crushed nerve was characterized by the sparing of small-diameter myelinated axons and intraepidermal nerve fibers, fewer dorsal root ganglia expressing the injury marker activating transcription factor 3, and lower serum levels of neurofilament light chain. By day 30, axons showed signs of reduced myelin thickness. In summary, the escape of small-diameter axons from Wallerian degeneration is likely a determinant of chronic pain pathophysiology distinct from the general response to complete nerve injury.

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Prevalence of post-traumatic neuropathic pain after digital nerve repair and finger amputation

Cited by 6 publications

References 42 publications

Application of Adipose Stem Cells in 3D Nerve Guidance Conduit Prevents Muscle Atrophy and Improves Distal Muscle Compliance in a Peripheral Nerve Regeneration Model

Application of Adipose Stem Cells in 3D Nerve Guidance Conduit Prevents Muscle Atrophy and Improves Distal Muscle Compliance in a Peripheral Nerve Regeneration Model

Patient reported symptoms and disabilities before and after neuroma surgery: a register-based study

Long-term tactile hypersensitivity after nerve crush injury in mice is characterized by the persistence of intact sensory axons

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