Treatment of neuropathic deafferentation pain using DREZ lesions; long-term results

Abstract

Introduction Deafferentation pain secondary to spinal cord injury, brachial plexus avulsion and other peripheral nerve injuries is often refractory to conventional treatments. This study evaluates the long-term efficacy of spinal DREZ (Dorsal Root Entry Zone) lesions for the treatment of neuropathic pain syndromes caused by deafferentation. Patients and methods A series of 18 patients with refractory deafferentation pain treated with radiofrequency DREZ lesions is presented. The immediate and long-term efficacy was measured with the Visual Analogue Scale (VAS) before and after treatment, the patient's subjective evaluation, the percentage of patients returning to work and the reduction in pain medication. Results Pain on the VAS significantly decreased from 8.6 preoperatively to 2.9 (p < .001) at release. Over the long-term, with a mean follow-up of 28 months (6–108) pain remained at 4.7 on the VAS (p < 0.002). The percentage of patients with moderate to excellent pain relief was 77% at discharge and 68% at the last follow-up. Pain medication was reduced in 67% of the patients and 28% returned to work. The best results were obtained in patients with brachial plexus avulsion, with a significant long-term pain relief in all cases. Conclusions Radiofrequency DREZ lesion is an effective and safe treatment for refractory neuropathic pain caused by deafferentation.