Painful nerve injuries: bridging the gap between basic neuroscience and neurosurgical treatment

Pain which followed suspected nerve injury was comprehensively evaluated with detailed examination including history, neurologic exam, electrodiagnostic studies, quantitative sensory testing, thermography, anesthetic and sympathetic nerve blocks. Forty two patients treated surgically fell into four discrete groups: 1) Distal sensory neuromas treated by excision of the neuroma and reimplantation of the proximal nerve into muscle or bone marrow, 2) Suspected distal sensory neuromas in which the involved nerve was sectioned proximal to the injury site and reimplanted, 3) Proximal neuromas-incontinuity of major sensorimotor nerves treated by external neurolysis, and 4) Proximal major sensorimotor nerve injuries at points of anatomic entrapment treated by external neurolysis and transposition, if possible. Patient follow up was possible in 40/42 patients (95%) from 2-32 months (average F/U = 11 mo.). Surgical success was defined as: > or = 50% improvement in pain (VAS) or pain relief subjectively rated as good or excellent, and no postoperative narcotic usage. Overall, 40% (16/40) of patients met those criteria. Success rates varied as follows: Group 1 (n = 18) 44%, Group 2 (n = 10) 40%, Group 3 (n = 5) 0%, and Group 4 (n = 7) 57%. A total of 12 of 40 patients (30%) were employed both pre- and postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)