BACKGROUND: Pain after traumatic brachial plexus avulsion (BPA) has 2 distinct patterns: continuous burning pain and paroxysmal shooting pain. Lesioning of the dorsal root entry zone (DREZotomy) is more effective for paroxysmal than continuous pain. It is unknown, however, whether electric motor cortex stimulation (EMCS) has a differential effect on continuous vs paroxysmal BPA pain. OBJECTIVE: To analyze the differential effect of EMCS and DREZotomy on continuous vs paroxysmal BPA pain in a series of 15 patients. METHODS: Fifteen patients with intractable BPA pain underwent DREZotomy alone (n = 7), EMCS alone (n = 4), or both procedures (n = 4). Pain intensity was evaluated with the Visual Analog Scale, and separate ratings were recorded for paroxysmal and continuous pain. Pain relief was categorized as excellent (> 75% pain relief), good (50%-75%), or poor (< 50%). Favorable outcome was defined as good or better pain relief. RESULTS: Eight patients had EMCS; 7 were followed up for an average of 47 months. Of those 7 patients, 3 (42%) with continuous pain had favorable outcomes compared with no patients with paroxysmal pain. Eleven patients had DREZotomy; 10 were followed up for an average of 31 months. Of those 10 patients, 7 (70%) with paroxysmal pain had favorable outcomes compared with 2 (20%) with continuous pain. CONCLUSION: EMCS was ineffective for paroxysmal pain but moderately effective for continuous pain. DREZotomy was highly effective for paroxysmal pain but moderately effective for continuous pain. It may be prudent to use EMCS for residual continuous pain after DREZotomy.
BACKGROUND:Pain after traumatic brachial plexus avulsion (BPA) has 2 distinct patterns: continuous burning pain and paroxysmal shooting pain. Lesioning of the dorsal root entry zone (DREZotomy) is more effective for paroxysmal than continuous pain. It is unknown, however, whether electric motor cortex stimulation (EMCS) has a differential effect on continuous vs paroxysmal BPApain. OBJECTIVE: To analyze the differential effect of EMCS and DREZotomy on continuous vs paroxysmal BPApain in a series of 15 patients. METHODS: Fifteen patients with intractable BPApain underwent DREZotomy alone (n = 7), EMCS alone (n = 4), or both procedures (n = 4). Pain intensity was evaluated with the Visual Analog Scale, and separate ratings were recorded for paroxysmal and continuous pain. Pain relief was categorized as excellent (> 75% pain relief), good (50%-75%), or poor (< 50%). Favorable outcome was defined as good or better pain relief. RESULTS: Eight patients had EMCS; 7 were followed up for an average of 47 months. Of those 7 patients, 3 (42%) with continuous pain had favorable outcomes compared with no patients with paroxysmal pain. Eleven patients had DREZotomy; 10 were followed up for an average of 31 months. Of those 10 patients, 7 (70%) with paroxysmal pain had favorable outcomes compared with 2 (20%) with continuous pain. CONCLUSION: EMCS was ineffective for paroxysmal pain but moderately effective for continuous pain. DREZotomy was highly effective for paroxysmal pain but moderately effective for continuous pain. It may be prudent to use EMCS for residual continuous pain after DREZotomy.
Authors: Jung Hyun Kim; Sang Ho Shin; Young Rong Lee; Hyo Seon Lee; Jin Young Chon; Choon Ho Sung; Sung Jin Hong; Ji Young Lee; Ho Sik Moon Journal: J Anesth Date: 2017-02-11 Impact factor: 2.078
Authors: Manoel Jacobsen Teixeira; Matheus Gomes da S da Paz; Mauro Tupiniquim Bina; Scheila Nogueira Santos; Irina Raicher; Ricardo Galhardoni; Diego Toledo Fernandes; Lin T Yeng; Abrahão F Baptista; Daniel Ciampi de Andrade Journal: BMC Neurol Date: 2015-05-04 Impact factor: 2.474
Authors: Alan Chalil; Qian Wang; Mohamad Abbass; Brendan G Santyr; Keith W MacDougall; Michael D Staudt Journal: Front Pain Res (Lausanne) Date: 2021-11-17