[Potential limitations and risks in the treatment of painful neuropathies]

Neuropathic pains often cause social disintegration of the patients, encouraging us to apply microsurgical techniques to peripheral nerve lesions, but there are limitations and risks to take into account when handling scarred nerve tissue.

The historical development of our microanatomical knowledge of grading of nerve lesions as well as facts on different fibrotic intraneural reactions are pointed out and additionally compared to today's theories of the origin of neuropathic pains.

The microsurgical methods applied to entrapment syndromes, pseudoneuroma and neuroma formations consist of either external and interfascicular neurolysis or nerve grafting depending on the estimated grade of nerve lesion. If we primarily don't try to restore motor function after a nerve lesion but intend to achieve reduction of neuropathic pain due to a scarred nerve, the well-known methods of neuromodulation or thermic/cryoneurotomy increasingly become the treatment of choice.

There is no real mental connection existing between our successful microsurgical methods on restoration of nerve function and the theories of the origin of neuropathic pains. We do treat pain of nociceptive origin by means of neurolysis but have abandoned these methods more and more in the case of chronic neuropathic pain. But on the other hand, the neuromodulation and neurotomy methods preferred in these cases still have limitations in compatibility and success rates. In a few cases we even risk inducing or worsening chronic neuropathic pains by means of microsurgery and/or neurotomy of a lesioned nerve.