Chapter 4 - Management of Peripheral Nerve Neuralgia

Abstract

Peripheral nerve neuralgia or neuropathic pain may result from neuropathy of various etiologies (medical), nerve compression (entrapment), peripheral nerve injury (trauma), or a combination of the above. In addition to regional changes in the peripheral nerve, a cascade of pathologic changes may occur within the dorsal root and spinal cord, which lead to central sensitization. Clinical assessment must determine which peripheral nerve or nerves is/are affected as well as whether central sensitization has occurred to inform the clinician which treatment may be optimal for the patient. Treatment strategies usually start with pharmacotherapy with antineuropathic drugs to reduce the excitability of the peripheral nerve and central connections. Surgical interventions for refractory peripheral nerve pain may range from decompression, resection of the neuroma (if identified), and careful redirection of the proximal cut end to proximal nerve or root lesioning or a neuromodulation strategy. Understanding the psychosocial milieu of the patient's pain experience is also important to set appropriate expectations and predict success from any intervention.