Pain relief after nerve resection for post-traumatic neuralgia.

We performed resection of part of an injured peripheral nerve in 20 patients with post-traumatic neuralgia, after conservative treatment had failed. All had burning pain, paraesthesia and dysaesthesia in the area innervated by the injured nerve. We resected the nerve in the area in which the patient felt pain, and a further 3 cm proximal to the site of injury. In all cases, the local pain disappeared or markedly decreased. The areas of pain relief and of nerve resection coincided completely in 17 patients and partially in three. The results were assessed as excellent by five patients, good by 11, and fair by four. There were no poor results. Histological examination of the resected nerves showed Wallerian degeneration and immunohistochemical tests indicated that substance P, a polypeptide which may contribute to nociceptive transmission, was present in the tissue around the degenerated nerves.

[1]  J. Henry,et al.  Effects of substance P on functionally identified units in cat spinal cord , 1976, Brain Research.

[2]  J. Bonica Causalgia and other reflex sympathetic dystrophies. , 1973, Postgraduate medicine.

[3]  R. Birch,et al.  Surgical Disorders of the Peripheral Nerves , 1998 .

[4]  L. Lankford,et al.  Reflex Sympathetic Dystrophy , 1990, Current Management of Pain.

[5]  R. Barnes,et al.  The role of sympathectomy in the treatment of causalgia. , 1953, The Journal of bone and joint surgery. British volume.

[6]  I. Whitworth Surgical Disorders of the Peripheral Nerves. , 1999, Journal of neurology, neurosurgery, and psychiatry.

[7]  J. Thopson The diagnosis and management of post-traumatic pain syndromes (causalgia). , 1979 .

[8]  J. Thompson The diagnosis and management of post-traumatic pain syndromes (causalgia). , 1979, The Australian and New Zealand journal of surgery.

[9]  D. Hodges,et al.  Burning and pain after injury. Is it causalgia or reflex sympathetic dystrophy? , 1988, Postgraduate medicine.

[10]  F. Lembeck,et al.  Substance P in peripheral sensory processes. , 2008, Ciba Foundation symposium.

[11]  H. B. Shumacker A Personal Overview of Causalgia and Other Reflex Dystrophies , 1985, Annals of surgery.

[12]  T. Getchell,et al.  Effect of substance p on mechanosensitive units of tissues around and in the lumbar facet joint , 1993, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[13]  T. Yaksh Substance P release from knee joint afferent terminals: modulation by opioids , 1988, Brain Research.

[14]  J. Polak,et al.  SUBSTANCE P: A NATURALLY OCCURRING TRANSMITTER IN HUMAN SPINAL CORD , 1976, The Lancet.

[15]  J. Walton Nerves and nerve injuries , 1969 .

[16]  H. Takagi,et al.  Release of substance P from the spinal dorsal horn is enhanced in polyarthritic rats , 1987, Neuroscience Letters.