Sir Victor Horsley, Mr John Marshall, the Nervi Nervorum, and Pain

Vilensky, Joel A.; Gilman, Sid; Casey, Kenneth L.

doi:10.1001/archneur.62.3.499

Cited by 15 publications

(9 citation statements)

References 7 publications

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“…A potential benefit of the use of fluid (hydro) to separate nerves from the surrounding soft tissue (dissection) to treat neuropathic pain is the release of pressure on the "free nerves supplying the main nerves," which are called "nervi nervorum," [16][17][18][19][20] which are located outside the epineurium. The nervi nervorum innervate and regulate the function and discharge of sensory, motor, or mixed-modality nerves (Figure 1).…”

Section: Potential Benefits Of Decompression On Nervi Nervorum Vasa mentioning

confidence: 99%

<p>Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms</p>

Lam¹,

Hung²,

Chiang³

et al. 2020

JPR

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Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves the injection of an anesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue, fascia, or adjacent structures. Animal models suggest the potential for minimal compression to initiate and perpetuate neuropathic pain. Mechanical benefits of HD may relate to release of nervi nervorum or vasa nervorum compression. Pathologic nerves can be identified by examination or ultrasound visualization. The in-plane technique is the predominant and safest method for nerve HD. Five percent dextrose may be favored as the preferred injectate based on preliminary comparative-injectate literature, but additional research is critical. Literature-based hypotheses for a direct ameliorative effect of dextrose HD on neuropathic pain are presented.

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Section: Potential Benefits Of Decompression On Nervi Nervorum Vasa mentioning

confidence: 99%

<p>Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms</p>

Lam¹,

Hung²,

Chiang³

et al. 2020

JPR

View full text Add to dashboard Cite

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“…A potential benefit of separation of nerves from the surrounding soft tissue with fluid (hydro) and with the fluid flushing, or enclosing the nerve to treat neuropathic pain, is the release of pressure on the "free nerves supplying the main nerves," which are called "nervi nervorum," [16][17][18][19][20] outside the epineurium. These "nervi nervorum" innervate and regulate the function and discharge of the main nerves.…”

Section: Idiopathic Acute or Chronic Neuropathic Pain Without An Appamentioning

confidence: 99%

Ultrasound-Guided Nerve Hydrodissection for Pain Management: An Updated Review of Anatomy and Techniques

Lam¹,

Hung²,

Chiang³

et al. 2020

Preprint

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Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves using an anesthetic or solution such as saline or 5% dextrose solution to separate the nerve from the surrounding tissue, fascia, or adjacent structures. This technique aims to treat neuropathic pain, or pain caused by the nerve. Ultrasound-guided HD of peripheral nerves has gained significant attention in the medical profession and pain management fields in recent years. This is due to a number of high impact publications of randomized control trials demonstrating the efficacy and safety of this technique for the treatment of carpal tunnel syndrome. Even the 20th edition of Harrison’s Principles of Internal Medicine textbook lists injection of 5% dextrose as an alternative local treatment that does not have the side effects of corticosteroids. At present, there is no review of the current literature on this technique. This manuscript will summarize and discuss the following: 1) the different approaches to doing ultrasound-guided HD of nervous structures, 2) its usages in different clinical situations, 3) its clinical pearls, 4) the solution used, and 5) the postulated mechanisms of action.

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“…In the publications "Nerve stretching for the relief of pain", Marshall has inferred that nervi nervorum would participate in pain generation mechanism observed in cases of peripheral nerves compression 27 . Together with Horsley 28 he has shown that nervi nervorum were sensitive to pain, especially to pressure 29 . Hromada 22 has observed that nervi nervorum originated from vasa vasorum nervous plexus or from nervous trunks themselves where they reached their targets following blood vessels.…”

Section: Organization Of Peripheral Nociceptive Nervous Systemmentioning

confidence: 99%

“…However, there is mechanical allodynia during nervous trunk palpation of compression or tension applied along the length of nervous trunks when nervi nervorum become sensitized. The possibility that pain from PNS injury may be neurogenic is not recent 28,29 . Nervi nervorum actively participate in the presence of pain in cases of PNS injury 48 .…”

Section: Peripheral Neuropathic Pain Pathophysiologymentioning

confidence: 99%

Concept of acute neuropathic pain. The role of nervi nervorum in the distinction between acute nociceptive and neuropathic pain

Teixeira

Almeida²,

Yeng

2016

Revista Dor

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BACKGROUND AND OBJECTIVES:Several pathophysiological mechanisms are involved in the genesis of neuropathic pain. However, available justifications for its onset are unsatisfying and do not explain the participation of nervi nervorum and nervi vasorum abnormalities on functional aberrations which characterize pain generated by injuries to the peripheral nervous system. There are evidences that nervi nervorum contribute to the development and justify many clinical findings and prophylactic, therapeutic and rehabilitation alternatives related to neuropathic pain. This study aimed at presenting a review of anatomic and functional studies and theories about their objectives and at giving examples of conditions in which nervi nervorum have markedly participated in neuropathic pain generation and maintenance. CONTENTS: Nervi nervorum are a set of unmyelinated or poorly myelinated fibers located in peripheral nerves sheaths which, among other functions, seem to participate in the transmission of evoked sensory information and in the environmental regulation of peripheral nervous system structures. CONCLUSION: Nervi nervorum structural and functional abnormalities may contribute to the onset, maintenance and worsening of neuropathic pain and "demodulatory" painful syndromes. Further studies, especially with the application of more specific and sensitive histological, biochemical and electrophysiological methods are necessary to clarify the realities of their biologies. Keywords: Nervi nervorum, Neuropathic pain, Nociceptive pain, Pathophysiology, Peripheral nerves. RESUMO JUSTIFICATIVA E OBJETIVOS:Diversos mecanismos fisiopatológicos estão envolvidos na gênese das dores neuropáticas. Entretanto as justificativas disponíveis para sua ocorrência são insatisfatórias e em nada esclarecem a ocorrência das assim chamadas dores desmodulatórias. Há crescente interesse em se compreender a participação das anormalidades dos nervi nervorum e nervi vasorum nas aberrações funcionais que caracterizam as dores geradas pelas lesões que acometem o sistema nervoso periférico. Há evidências de que os nervi nervorum contribuem para desenvolvimento e justificam muitos dos achados clínicos e as alternativas profiláticas, terapêuticas e reabilitacionais relacionadas às dores neuropáticas. O objetivo deste estudo foi apresentar uma revisão sobre os estudos anatômicos e funcionais e as teorias sobre suas finalidades e exemplificar condições em que os nervi nervorum participam de modo marcante na sua geração e manutenção da dor neuropática. CONTEÚDO: Os nervi nervorum são um conjunto de fibras amielínicas ou pouco mielinizadas localizadas nas bainhas dos nervos periféricos que, dentre outras funções, parecem participar da veiculação de informações sensitivas evocaConcept of acute neuropathic pain. The role of nervi nervorum in the distinction between acute nociceptive and neuropathic pain INTRODUCTIONAccording to the International Association for the Study of Pain (IASP) definition, pain is "an unpleasant sensory and emotional experienc...

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Sir Victor Horsley, Mr John Marshall, the Nervi Nervorum, and Pain

Cited by 15 publications

References 7 publications

<p>Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms</p>

<p>Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms</p>

Ultrasound-Guided Nerve Hydrodissection for Pain Management: An Updated Review of Anatomy and Techniques

Concept of acute neuropathic pain. The role of nervi nervorum in the distinction between acute nociceptive and neuropathic pain

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