Document Detail


Pain syndromes after missile-caused peripheral nerve lesions: part 2--treatment.
MedLine Citation:
PMID:  17277686     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To analyze treatment procedures and treatment outcomes of painful missile-caused nerve injuries and factors influencing the outcome. METHODS: The study included 326 patients with clinically significant pain syndromes, including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Treatment modalities included drug therapy, nerve surgery, sympatholysis, and dorsal root entry zone operation. Pain intensity was assessed before and after the treatment using a visual analog scale, and treatment outcome was defined as successful (pain relief >70%), fair (pain relief between 50 and 69%), or poor (pain relief <50%). The outcome was compared between different pain syndromes and different treatment modalities. RESULTS: A successful outcome was achieved in 28.6% of patients with deafferentation pain, in 76.9% of patients with complex regional pain syndrome Type II, and in 87.9 to 100% of patients with other pain syndromes (P = 0.002). Each type of pain syndrome required a specific treatment algorithm, but average pain relief was similar for all definitive treatment modalities (range, 81-88%; P > 0.05). Ten factors were found to significantly influence the treatment outcome, but only three factors were independent predictors of a successful outcome: type of pain syndrome (P < 0.001), severity of nerve injury (P < 0.001), and absence of pain paroxysms (P = 0.03). CONCLUSION: The treatment outcome of painful nerve injury depends on several factors, including the type of pain syndrome, severance of nerve injury, and absence of pain paroxysms. Drug therapy (carbamazepine, amitriptyline, or gabapentin) should be recommended, at least as a part of treatment, for patients with reinnervation pain, deafferentation pain, and complex regional pain syndrome Type II. Nerve surgery should be recommended for patients with posttraumatic neuralgia, either as the first treatment choice (acute nerve compression or intraneural foreign particles) or after unsuccessful pharmacological treatment (other causes of neuralgic pain).
Authors:
Zoran Roganovic; Gordana Mandic-Gajic
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  59     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2007-02-05     Completed Date:  2007-02-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1238-49; discussion 1249-51     Citation Subset:  IM    
Affiliation:
Neurosurgical Department, Military Medical Academy, Belgrade, Serbia. roganovic@yubc.net
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Comorbidity
Complex Regional Pain Syndromes / epidemiology*,  therapy*
Female
Humans
Incidence
Male
Middle Aged
Military Personnel / statistics & numerical data*
Peripheral Nerves / injuries*
Syndrome
Trauma, Nervous System / epidemiology*
Treatment Outcome
War*
Wounds, Penetrating / epidemiology*
Yugoslavia / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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