Incidence Of Neuropathic Pain Research Articles

Long-term outcomes after terminalization for acute fingertip injuries.

The primary aim of this study was to report outcomes after fingertip terminalization in 90 patients over a 19-year period. We report excellent functional outcomes and satisfaction, but a 33% incidence of neuropathic pain.

The Frequency of Neuropathic Pain and Associated Factors in Patients with Rheumatoid Arthritis

Abstract Objective The aim of this study was to evaluate the presence and incidence of neuropathic pain (NP) in patients with rheumatoid arthritis (RA) and to determine the relationship between neuropathic pain scores, quality of life and functional status. Methods 119 patients with RA and 45 control subjects with acute non-inflammatory pain were recruited for the study. Disease activity with DAS28 (Disease Activity Score-28), pain visual analog scale, functional status and quality of life were recorded. Quality of life was evaluated with the Rheumatoid Arthritis Quality of Life Scale (RAQoL), and functional status was assessed with the Health Assessment Questionnaire (HAQ). The presence of NP was evaluated with the LANSS (Leeds Assessment of Neuropathic Symptoms and Signs), Douleur Neuropathique 4 (DN4) and painDETECT questionnaires (PDQ). Results The prevalence of NP according to LANSS, DN4 and PDQ was 63.9%, 58.8% and 51.3% in the RA group and 6.7%, 4.4% and 4.4% in the control group, respectively. NP scores were significantly higher in the RA group (p<0.001). LANSS, DN4 and PDQ scores correlated with VAS, HAQ and RAQoL scores. Conclusion The NP evaluated with different pain questionnaires is not rare in patients with RA and is related to functional status and quality of life.

1045 A 6-Year Cohort Study Assessing Outcomes Following Calf Fasciotomies at a Single Tertiary Vascular Trauma Centre

Abstract Background Acute compartment syndrome (ACS) is a surgical emergency.Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation.This study compared outcomes following prophylactic (Group1) versus therapeutic calf fasciotomies (Group2), as well as early (within 6 hours) versus delayed fasciotomies (>6 hours) at a single tertiary vascular trauma centre. Method All patients undergoing calf fasciotomies between 1st January 2017 and 31st November 2022 were identified from a prospectively collected vascular departmental database.The primary outcomes included foot drop, amputation and mortality while infection, wound debridement,neuropathic pain and negative-pressure dressing were secondary outcomes.Statistical analysis with SPSS was performed using Fisher’s exact test. Results 88 patients (65 men, 23 women) of median age (IQR) 67 (56-74) underwent calf fasciotomies.Of these, 43 (48.9%) were therapeutic (Median age = 62) and 45 (51.1%) were prophylactic (Median age = 67).Ischaemia was more prevalent among Group1 while trauma among Group2.There were no significant differences among outcomes between both groups apart from higher 30-day mortality rate (26.7% vs. 7.0%, p = 0.014)and incidence of neuropathic pain (22.2% vs. 4.7%, p = 0.027)in Group1 versus Group2.Most patients (79.5%) underwent early calf fasciotomy with no significant differences in primary and secondary outcomes between early and delayed fasciotomy groups.The delay was attributed to theatre unavailability (n = 6) and on-going resuscitation (n = 5) . Conclusions Higher rates of neuropathic pain and 30-day mortality in group1 may be attributed to co-existing lower limb ischaemia.Further work is required to establish the impact of neuropathic pain.Pathways should be developed to ensure rapid access to theatres for patients with suspected ACS.

O072 A 6-year cohort study assessing outcomes following calf fasciotomies at a single tertiary vascular trauma centre

Abstract Introduction Acute compartment syndrome (ACS) is a surgical emergency. Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation. This study compared outcomes following prophylactic (Group1) versus therapeutic calf fasciotomies (Group2), as well as early (within 6 hours) versus delayed fasciotomies (>6 hours) at a single tertiary vascular trauma centre. Methods All patients undergoing calf fasciotomies between 1st January 2017 and 31st November 2022 were identified from a prospectively collected vascular departmental database. The primary outcomes included foot drop, amputation and mortality while infection, wound debridement, neuropathic pain and negative-pressure dressing were secondary outcomes. Statistical analysis with SPSS was performed using Fisher's exact test. Results 88 patients (65 men, 23 women) of median age (IQR) 67 (56-74) underwent calf fasciotomies. Of these, 43 (48.9%) were therapeutic (Median age=62) and 45 (51.1%) were prophylactic (Median age=67).Ischaemia was more prevalent among Group1 while trauma among Group2.There were no significant differences among outcomes between both groups apart from higher 30-day mortality rate (26.7% vs. 7.0%, p=0.014)and incidence of neuropathic pain (22.2% vs. 4.7%, p=0.027)in Group1 versus Group2.Most patients (79.5%) underwent early calf fasciotomy with no significant differences in primary and secondary outcomes between early and delayed fasciotomy groups. The delay was attributed to theatre unavailability (n=6) and on-going resuscitation (n=5). Conclusion Higher rates of neuropathic pain and 30-day mortality in group1 may be attributed to co-existing lower limb ischaemia. Further work is required to establish the impact of neuropathic pain. Pathways should be developed to ensure rapid access to theatres for patients with suspected ACS.

Would Cutibacterium acnes Be the Villain for the Chronicity of Low Back Pain in Degenerative Disc Disease? Preliminary Results of an Analytical Cohort.

In the last decade, several studies have demonstrated Cutibacterium acnes colonization in intervertebral discs (IVDs) in patients with lumbar disc degeneration (LDD) and low back pain (LBP), but the meaning of these findings remains unclear. Being aware of this knowledge gap, we are currently conducting a prospective analytical cohort study with LBP and LDD patients undergoing lumbar microdiscectomy and posterior fusion. The IVDs samples collected during the surgeries are subjected to a stringent analytical protocol using microbiological, phenotypic, genotypic, and multiomic techniques. Additionally, pain-related scores and quality-of-life indexes are monitored during patient follow-up. Our preliminary results for 265 samples (53 discs from 23 patients) revealed a C. acnes prevalence of 34.8%, among which the phylotypes IB and II were the most commonly isolated. The incidence of neuropathic pain was significantly higher in the colonized patients, especially between the third and sixth postoperative months, which strongly suggests that the pathogen plays an important role in the chronicity of LBP. The future results of our protocol will help us to understand how C. acnes contributes to transforming inflammatory/nociceptive pain into neuropathic pain and, hopefully, will help us to find a biomarker capable of predicting the risk of chronic LBP in this scenario.

Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life.

The radial forearm free flap (RFFF) is widely used and is considered one of the workhorse flaps in oncologic head and neck reconstructions. However, the potential for significant donor-site morbidity remains a major drawback. Although various donor-site problems have been reported, the incidence of neuropathic pain and possible predicting factors remain unclear. This study aimed to identify the incidence, prognostic factors, and impact on quality of life of neuropathic pain following RFFF harvest. In this multicenter, cross-sectional study, 167 patients who underwent an RFFF reconstruction between 2010 and 2020 were included. Baseline characteristics were collected by medical charts. All patients received questionnaires to measure patient's pain (Doleur Neuropathique 4 and visual analog scale, pain), hand function (Patient-Reported Wrist and Hand Evaluation), and quality of life (EuroQol 5D). Multiple logistic regression was used to identify prognostic factors associated with outcomes. A total of 114 patients (68%) completed the questionnaire. Neuropathic pain was present in 18% of all patients. Donor-site wound problems, mostly tendon exposure, occurred in 32% and was significantly correlated with neuropathic pain (p = 0.003). Neuropathic pain was significantly associated with poorer quality of life (p < 0.001) and poorer hand function (p < 0.001). Almost one-fifth of all patients deal with neuropathic pain following RFFF harvest. Neuropathic pain is significantly correlated with poorer hand function and a poorer quality of life. Therefore, future research should focus on analyzing surgical factors such as the management of wound problems and primary denervation to improve hand function and quality of life of these patients.

Identification of key candidate genes and biological pathways in neuropathic pain

BackgroundNeuropathic pain is a common chronic pain, characterized by spontaneous pain and mechanical allodynia. The incidence of neuropathic pain is on the rise due to infections, higher rates of diabetes and stroke, and increased use of chemotherapy drugs in cancer patients. At present, due to its pathophysiological process and molecular mechanism remaining unclear, there is a lack of effective treatment and prevention methods in clinical practice. Now, we use bioinformatics technology to integrate and filter hub genes that may be related to the pathogenesis of neuropathic pain, and explore their possible molecular mechanism by functional annotation and pathway enrichment analysis. MethodsThe expression profiles of GSE24982, GSE2884, GSE2636 and GSE30691 were downloaded from the Gene Expression Omnibus（GEO）database, and these datasets include 93 neuropathic pain Rattus norvegicus and 59 shame controls. After the four datasets were all standardized by quantiles, the differentially expressed genes (DEGs) between NPP Rattus norvegicus and the shame controls were finally identified by the robust rank aggregation (RRA) analysis method. In order to reveal the possible underlying biological function of DEGs, the Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway enrichment analysis of DEGs were performed. In addition, a Protein-protein Interaction (PPI) network was also established. At the end of our study, a high throughput sequencing dataset GSE117526 was used to corroborate our calculation results. ResultsThrough RRA analysis of the above four datasets GSE24982, GSE2884, GSE2636, and GSE30691, we finally obtained 231 DEGs, including 183 up-regulated genes and 47 down-regulated genes. Arranging 231 DEGs in descending order according to |log2 fold change (FC)|, we found that the top 20 key genes include 14 up-regulated genes and 6 down-regulated genes. The most down-regulated hub gene abnormal expressed in NPP was Egf17 (P-value = 0.008), Camk2n2 (P-value = 0.002), and Lep (P-value = 0.02), and the most up-regulated hub gene abnormal expressed in NPP was Nefm (P-value = 1.08E-06), Prx (P-value = 2.68E-07), and Stip1 (P-value = 4.40E-07). In GO functional annotation analysis results, regulation of ion transmembrane transport (GO:0034765; P-value = 1.45E-09) was the most remarkable enriched for biological process, synaptic membrane (GO:0097060; P-value = 2.95E-08) was the most significantly enriched for cellular component, channel activity (GO:0015267; P-value = 2.44E-06) was the most prominent enriched for molecular function. In KEGG pathway enrichment analysis results, the top three notable enrichment pathways were Neuroactive ligand-receptor interaction (rno04080; P-value = 3.46E-08), Calcium signaling pathway (rno04020; P-value = 5.37E-05), and Osteoclast differentiation (rno04380; P-value = 0.000459927). Cav1 and Lep appeared in the top 20 genes in both RRA analysis and PPI analysis, while Nefm appeared in RRA analysis and datasets GSE117526 validation analysis, so we finally identified these three genes as hub genes. ConclusionsOur research identified the hub genes and signal pathways of neuropathic pain, enriched the pathophysiological mechanism of neuropathic pain to some extent, and provided a possible basis for the targeted therapy of neuropathic pain.

Triptolide Alleviates Neuropathic Pain by Inhibiting the Activation of Microglial Toll-Like Receptor 3.

Current data indicates the incidence of neuropathic pain after surgical nerve injury is as high as 50%, thus representing a major problem for patients and for the medical system. Triptolide, a traditional Chinese herb, has anti-inflammatory effects on various neurodegenerative and neuroinflammatory diseases. This agent also reduces peripheral nerve injury-induced neuropathic pain, although the mechanism underlying this effect is still unknown. The effects of triptolide on spinal nerve ligation (SNL) injury-induced neuropathic pain was studied in an animal model using behavioral, morphological and molecular biological methods. Repeated administration of intrathecal triptolide was found to alleviate SNL- or Poly(I:C) (toll-like receptor 3 agonist) injection-induced mechanical allodynia without any motor impairment. The mechanism by which triptolide reduces SNL- and Poly(I:C) injection-induced microglial activation appears to be via the inhibition of OX42 expression, which is a microglial-specific marker. Intrathecal triptolide also suppressed SNL- and Poly(I:C) injection-induced expression of spinal TRIF. TRIF transmits signals from activated TLR3 and is the downstream adaptor of TLR3 in microglia. In addition, intrathecal triptolide inhibited the expression of spinal pro-inflammatory IL-1 β following SNL or Poly(I:C) injection. Intrathecal triptolide can suppress the TLR3/TRIF/IL-1 β pathway in spinal microglia following SNL. This could be the underlying mechanism by which triptolide alleviate neuropathic pain induced by peripheral nerve injury.

Post-traumatic Trigeminal Neuropathic Pain: Factors Affecting Surgical Treatment Outcomes.

Post-traumatic trigeminal neuropathic pain (PTTNp) is a painful condition that may result from injury to the sensory division of the trigeminal nerve. Treatment of this condition is challenging and consensus on treatment to resolve neuropathic pain has yet to be standardized. Equally as challenging is the identification of surgical outcome variables to guide surgical treatment of PTTNp. This is partly due to the variability in pain characteristics, severity of nerve injury, location, and duration from injury to surgery. In those with neuropathic pain prior to microsurgical intervention, the incidence of neuropathic pain after microsurgical intervention is 67%. It is unclear why nerve repair surgery is effective in resolving or decreasing neuropathic pain in some patients, whereas it has no effect on pain relief in others. Psychological, medical, and age-related factors have been identified as risk factors for developing chronic post-surgical pain due to post-traumatic neuropathic pain. Two factors: injury to surgery time and preoperative visual analog scale score have recently been identified as variables that influence surgical outcomes in the treatment of PTTNp.

A comparative study to analyze the effect of gabapentin with amitriptyline versus pregabalin with amitriptyline in neuropathic pain in cancer patients undergoing palliative care

Introduction: Antiepileptics and antidepressant medications are known for managing neuropathic pain. We aim to compare the effects of pregabalin with low-dose amitriptyline and gabapentin with low-dose amitriptyline in managing neuropathic pain in cancer patients undergoing palliative care. Materials and Methods: We conducted our study on 160 cancer patients who were having neuropathic pain and were undergoing palliative care treatment in our institute. It was a hospital-based, randomized, tertiary cancer center-based observational study. After taking approval from the institutional ethics committee and taking written informed consent from patients, the patients were divided into two groups and the effect of medicines on incidence of neuropathic pain was observed; the incidence of burning sensation and the incidence of adverse effects of medications were also analyzed. Statistical analysis was done using paired t-test and SPSS version 20 software. Results: The onset of relief in pain was earlier in the pregabalin group as compared to the gabapentin group. There was more reduction in a burning sensation in the pregabalin group as compared to the gabapentin group. The incidence of headaches was the same in both groups. Nausea and vomiting were more in the pregabalin group but the overall difference in adverse effects was not statistically significant (P > 0.05) Conclusions: In the management of neuropathic pain in cancer patients who are undergoing palliative care, a combination of pregabalin with amitriptyline was found to be more effective in pain relief than gabapentin with amitriptyline.

Preservation of the Intercostobrachial Nerve during Axillary Dissection for Breast Cancer at the Surgical Oncology Unit of Cancer Department of Dakar University

The intercostobrachial nerve (ICBN) is responsible for the sensory innervation of a part of the inner side of the arm. Injury of the intercostobrachial nerve is a complication of axillary dissection during lymph node dissection. Objective: This study aimed to determine the effect of preservation of the intercostobrachial nerve on postoperative sensory disturbances. Methods: This is a prospective, single-center study which was carried out in 90 patients followed in the oncology department of the Aristide Le Dantec hospital in Dakar, suffering from breast cancer and having undergone breast surgery associated with axillary dissection, for a period of 6 months. The patients were divided into two groups depending on whether the intercostobrachial nerve (ICBN) was preserved or not. The two groups were compared in terms of the incidence of sensory disturbances. Results: Sixty patients without nerve preservation and 30 patients with nerve preservation were included in the study, i.e., 90 patients in total. ICBN was injured in 60 patients of which 41 patients (83.7%) developed numbness in the inner arm. While in the preserved group, only 8 patients suffered from numbness (16.3%) with a significant P value of 0.002; however, for other variables such as the incidence of neuropathic pain and hypoesthesia-like sensory deficit, there was no significant difference. Conclusion: Preservation of the intercostobrachial nerve during axillary dissection for breast cancer reduces the incidence of sensory disturbances on the upper limb.

Early Surgical Decompression versus Medical Treatment in Acute Traumatic Central Cord Syndrome: Prospective Randomized Controlled Study

BACKGROUND: Traumatic central cord syndrome was first described by Schneider and colleagues as a spinal cord injury in 1954. Other definitions were not apart from the fact of greater weakness of upper limbs than lower limbs. Surgical treatment was mentioned frequently for plateaued neurological insult. OBJECT: This study aimed to examine the functional outcome of early surgical decompression for acute traumatic central cord syndrome. METHODS: After gaining ethical approval, 37 patients with acute traumatic central cord syndrome (ATCCS) were randomized into two groups, (medical and surgical group). The medical group was treated by intravenous fluids, neurotonics, and high doses of steroids. The surgical group was treated by laminectomy of the affected levels and duraplasty with fascia lata. The American Spinal Injury Association (ASIA) impairment scale, the incidence of neuropathic pain, urinary symptoms, and hospital stay were tested. RESULTS: It has been found that both the surgical group and the conservative group had a great improvement in ASIA motor function score with a highly statistically significant difference (<0.001) at 3 months follow up. Neuropathic pain showed more improvement in the surgical group and reached a dramatic response at the final visit. Urine retention declined in prevalence at discharge and the final visit was not dramatic. Hospital stay exhibited lengthy admission in the conservative group than the surgical group (p < 0.0001). CONCLUSION: Surgical decompression offers clinical improvement that might be superior to medical treatment. The decision of surgery should be closely disclosed with patients' family and relatives.

The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response

ABSTRACT Background Modified radical mastectomy (MRM) with axillary clearance of lymph nodes was routinely performed under general anaesthesia with intra- and postoperative opioid analgesia. Recently, there has been a move toward opioid-free anesthesia (OFA) to appreciate the goals of hypnosis with amnesia and sympathetic stability without the adverse effects of opioids. The aim of this study was to evaluate the effect of OFA versus opioid-based anaesthesia (OBA) in patients with breast cancer, who had undergone unilateral MRM. The primary aims • Pain intensity using the visual analogue scale in the first 24 h post-operatively. • Screening for post mastectomy neuropathic pain. The secondary aims • Effect of opioid and surgical stress on the immune system. • Patient outcome including haemodynamic stability, patient satisfaction and occurrence of post-operative complications. Methods Forty adult female patients scheduled for elective unilateral MRM were randomly divided into two groups (20 patients in each group): OFA and OBA. Results There was statistically significant decrease in pain score at rest and on movement in the OFA group. Postoperative nausea and vomiting was significantly decreased in the OFA group (P = 0.04). Patients in the OFA group were more satisfied than those in the OBA group using verbal rating scale for satisfaction (P < 0.001). There was significant low incidence of neuropathic pain in the OFA group; also, we found significant changes in interleukin 10, tumour necrosis factor alpha and caspase 3 between the two groups. Conclusion OFA is safe and effective in mastectomy as it decreases the pain score and the incidence of post mastectomy neuropathic pain; moreover, it also shows better immune response postoperatively.

Study on patients undergoing thoracic surgery. Incidence of chronic pain and influence of the type of intraoperative analgesia

Introduction Interventions performed in thoracic surgery are associated with moderate to severe postoperative pain, and has a high risk of developing chronic pain after thoracic surgery (CPATS). The main analgesic techniques are thoracic epidural analgesia (TEA), paravertebral block (PVB) and opioid management. Although it has been seen that there are no significant differences in postoperative analgesia between TEA and PVB [1,2], the comparison between both techniques in the prevention of CPATS has not been sufficiently investigated[2,3] and needs more evidence. Methods It is an observational, descriptive, retrospective study. The patient selection algorithm is shown in Figure 1. We made phone calls to patients. With the data collected we developed a database that included the variables: sex, age, type of intervention, intraoperative analgesic technique, analog visual pain scale (VAS) upon admission to the ICU, presence of chronic pain, VAS current and modified DN4 scale (table 1). Results The variables analyzed are shown in table 2. The risk of CPATS in this sample was higher in women (40.38%) than in men (29.01%) OR 1.39 95% CI [0.91-2.13]. In relation to age, the risk of CPATS in those under 60 was 44.07%, and in those over 60, 26.61%; with those under 60, 17.45% [2.6-32] of greater risk: OR 2.163 [1.12-4.17] (p = 0.01). The patients presented the same risk of chronic pain using regional analgesia (RA) 32.35% versus opioid management (32.41%). The incidence of neuropathic pain was 31.9% when RA was used versus 33.3% when opioid analgesia was used. In relation to the surgical technique, the risk of chronic pain in those undergoing thoracotomy was 40.42%, and in those subjected to VATS of 22.99%; the patients undergoing thoracotomy had 17.43% [4.14-30.72] of greater risk: OR 2.23 [1.18-4.38] (p = 0.006). Regarding the RA technique, the risk of CPATS in those undergoing TEA was 27.72%, and in those undergoing PVB 45%: OR 0.61 [0.38-0.98] (p = 0.048). The mean VAS at admission among patients receiving TEA and PVB was 2.62 ± 2.04 vs. 3.15 ± 1.98 (p = 0.167). Discussion The comparison of RA techniques in thoracic surgery has been widely studied, especially TEA and PVB. In our study, we observed no differences between RA techniques with respect to postoperative analgesia. The RA technique in relation to the development of CPATS has been much less studied. We have observed in our study that the use of epidural is a protective factor compared to patients undergoing paravertebral analgesia (p = 0.048). Although this fact may be due to a higher failure rate in performing the PVB technique in our environment.

The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure.

Intercostal nerve cryoblation during the Nuss procedure for pectus excavatum decreases pain, opiate requirement, and hospital length of stay (LOS) compared to thoracic epidural analgesia. However, long-term complications of cryoablation, including neuropathic pain development, are not well studied. We conducted a multi-institutional retrospective review of patients following intercostal nerve cryoablation during Nuss bar insertion (11/2015-7/2018). Patients completed the Leeds Assessment of Neuropathic Symptoms and Signs, a validated questionnaire for detecting neuropathic symptoms. Primary outcome was neuropathic pain development. Secondary outcomes included duration of chest numbness and LOS. T test was performed; p < 0.05 is significant. 43 patients underwent intercostal cryoablation during the Nuss procedure. Ages at repair ranged 11-47years (median 16). Patients were grouped by age: ≤ 21years (30 patients) or older (13 patients). Mean LOS was shorter for the younger group, 2.0 versus 3.9days (p = 0.03). No patients in the younger group, and three in the older, experienced neuropathic pain. Mean time to numbness resolution was shorter for the younger group, 3.4 versus 10.8months (p = 0.003). In pediatric patients, intercostal cryoablation provides effective analgesia following the Nuss procedure with minimal risk of post-operative neuropathic pain. Adult patients are at greater risk of experiencing neuropathic pain and prolonged numbness.

Effect of transversus abdominis plane block on chronic postoperative pain after inguinal hernia repair

Aim: The aim of the study is to evaluate the effect of transversus abdominis plane block on chronic postoperative pain after inguinal hernia repair. Methods: Prospective randomized double blinded study is conducted on 40 male patients posted for inguinal hernia repair under spinal anaesthesia. Divided into 2 equal groups. Group I received USG TAP block with 20 ml of 0.25% bupivacaine whereas Group II received 20 ml of normal saline (Placebo) at the end of surgery. Postoperative VAS scores, analgesic consumption, DN4 scoring at 3 and 6 months to evaluate chronic pain were studied.Results: Forty male patients were enrolled. Postoperative VAS scores of Group I had improved scores than Group II. Analgesic consumption is also reduced in Group I compared to Group II (156.6 ± 48.3 vs 282.1 ± 43.2) which was statistically significant. Incidence of neuropathic pain in Group II was 5% at 3 months and 10% at 6 months; whereas in Group I one patient scored ‘3’ at 3 months which reduced to ‘2’ at 6 months. No restriction of daily activities present in Group I patient.Conclusion: USG TAP block provided better postoperative VAS scores and analgesic consumption, along with the reduction in incidence of chronic pain than placebo.

The correlation between neuropathic pain incidence and vitamin d levels in patients with chronic low back pain

Aim: The present study aimed to investigate the correlation between neuropathic pain incidence and vitamin D levels in chronic mechanical low back pain.Material and Methods: Sixty patients (36 females, 24 males) with chronic mechanical low back pain (CMLBP) were included in the study. Leeds Assessment Neuropathic Symptoms and Signs Scale (LANSS), Beck Depression Inventory (BDI), and Visual Analogue Scale (VAS) were applied to the patients. Patient vitamin D levels were measured.Results: It was determined that the neuropathic low back pain incidence was 0.20. No statistically significant difference was determined between the neuropathic pain incidence in the group with subnormal vitamin D values and the group with normal vitamin D values (p = 0.292). The incidence of neuropathic pain was higher in the group with subnormal vitamin D levels when compared to the group with normal vitamin D values. Conclusion: It was demonstrated that neuropathic low back pain was more frequent among CMLBP patients with subnormal vitamin D values when compared to patients with normal vitamin D levels, albeit not statistically significantly. Vitamin D deficiency should be reviewed in the evaluation of CMLBP, neuropathic component of which was not well defined, and its treatment and management requires a multidisciplinary approach, and vitamin D treatment should be considered when necessary.

Treatment of neuropathic pain after peripheral nerve and brachial plexus traumatic injury.

Peripheral nerve and brachial plexus injuries typically cause severe impairment in the affected limb. The incidence of neuropathic pain is high, reaching up to 95% of cases, especially if cervical root avulsion has occurred. Neuropathic pain results from damage to the somatosensory system, and its progression towards chronicity depends upon disruptions affecting both the peripheral and central nervous system. Managing these painful conditions is complex and must be accomplished by a multidisciplinary team, starting with first-line pharmacological therapies like tricyclic antidepressants and calcium channel ligands, combined physical and occupational therapy, transcutaneous electrical stimulation and psychological support. For patients refractory to the initial measures, several neurosurgical options are available, including nerve decompression or reconstruction and ablative/modulatory procedures.

Treatment of neuropathic pain after peripheral nerve and brachial plexus traumatic injury.

Peripheral nerve and brachial plexus injuries typically cause severe impairment in the affected limb. The incidence of neuropathic pain is high, reaching up to 95% of cases, especially if cervical root avulsion has occurred. Neuropathic pain results from damage to the somatosensory system, and its progression towards chronicity depends upon disruptions affecting both the peripheral and central nervous system. Managing these painful conditions is complex and must be accomplished by a multidisciplinary team, starting with first-line pharmacological therapies like tricyclic antidepressants and calcium channel ligands, combined physical and occupational therapy, transcutaneous electrical stimulation and psychological support. For patients refractory to the initial measures, several neurosurgical options are available, including nerve decompression or reconstruction and ablative/modulatory procedures.

The clinical effect of the application of small diameter artificial nerve conduit on preventing neuropathic pain after crush injury of the digital nerve

Objective To observe the clinical effect of the application of small diameter artificial nerve conduit on preventing and reducing the occurrence of neuropathic pain after crush injury of the digital nerve. Methods From January 2015 to June 2016, 37 patients (50 digits) diagnosed with crush injury of the digital nerve were randomly divided into artificial nerve group and control group. There were 19 patients (25 digits) in the experimental group and 18 patients (25 digits) in the control group. Both groups underwent surgical debridement and digital nerve repair by the same surgeon, and were followed up and evaluated at 2 weeks, 6 weeks, 3 months and 6 months after the surgery. Every patient was assessed with visual analogue scale (VAS) for the degree of neuropathic pain. Results In the artificial nerve experimental group, there were 2 patients (2 digits) with neuropathic pain symptoms at the peak 2 weeks after the operation which significantly relieved at 6 weeks. In the control group, there were 5 patients (8 digits) of neuropathic pain symptoms at the peak from 2 to 6 weeks which significantly relieved within 3 months after the operation. Statistics analysis indicated that patients in the artificial nerve group had less neuropathic pain than the control group. The degree of pain was relieved and the duration was shortened significantly. Conclusion The small diameter artificial nerve conduit can effectively protect the digital nerve subjected to crush injury, prevent adhesion of the impaired nerve and its surrounding tissue, reduce compression of the scar tissue, and relieve the degree of pain and decrease the incidence of neuropathic pain. Key words: Hand injuries; Treatment outcome; Artificial nerve canal; Neuropathic pain