[Pain management after post-traumatic brachial plexus lesions. Conservative and surgical therapy possibilities]

The occurrence of sever pain is one of the most disabling symptoms after the traumatic lesion of the brachial plexus. Avulsion of one or more cervical roots of the brachial plexus is the main cause of severe pain, known as deafferentation pain. Lesion of the dorsal horn of the cervical spinal cord due to root avulsion may lead to important pathological changes and scarring that are responsible for the induction of pain sensations. Different medical and surgical treatment modalities have been established to relief such pain after brachial plexus injury. In contrast to drug therapy, which usually offers only limited benefit, surgical treatment over the last years has shown positive results. Coagulation of the dorsal root entry zone (DREZ) is one of the most efficient surgical treatments for these patients. Understanding of the pathophysiological changes and different pain mechanisms induced by traumatic injury of the brachial plexus is fundamental for the planning and step-wise treatment of such patients.