Limb Pain Syndrome Research Articles

Clinical applications and efficacy of mirror neuron function

Mirror therapy aims to restore the function of a disabled body part by using the function of mirror neurons in the brain and mimicking the physiological activity of a healthy body part. The existence of mirror neurons was first discovered in the monkey brain, then they were proven to occur in the human brain. The working pattern is always the same. If one limb moves, the correct part of the brain is activated and the mirror neurons responsible for stimulating the other limbs are activated. This is how the "mirror" in the brain works. The therapy uses a box with a mirror on one side and hides the impaired limb in it.. When a healthy limb moves, it is reflected in the mirror. The brain receives it as a movement of an inefficient limb, even though it is only an illusion. It drives the recruitment of neural joints and provides the reconstruction of neural pathways. The activity of mirror neurons is used in rehabilitation, in mirror therapy (MT), observational action therapy (AOT) and their variants, such as therapies based on Virtual Reality (VR). A significant effect of this treatment was observed in phantom limb pain (PLP) and post-stroke syndromes, such as motor aphasia, hemiparesis of the lower or upper limb. There are reports on the use of MT in some mental diseases or in autistic people in learning emotions. This review outlines the current possibilities and hopes for therapies based on mirror neuron functions based on selected cases.

Quality of Life Estimate of Patients with Chemotherapy-Induced Distal Polyneuropathy after High-Intensity Pulsed Magnetic Therapy: a Randomized Clinical Study

INTRODUCTION. The development of peripheral polyneuropathy in cancer patients after chemotherapy has a high prevalence and represents an important medical and social problem. Currently, a number of physiotherapeutic methods are used to treat peripheral polyneuropathy induced by chemotherapy (PPIC). AIM. To study clinical efficacy of high-intensity pulsed magnetic therapy in patients with PPIC according to indicative quality of life indicators. MATERIALS AND METHODS. 90 patients with PPIC were included in the study. The mean age of the patients was 57.3 ± 5.3 years. Two groups were formed by randomization method: control group patients (n = 45) received standard drug therapy; main group patients (n = 45) received 10 high-intensity pulsed magnetic therapy (HIPMT) procedures every other day against the background of standard therapy. We analyzed clinical complaints, pain syndrome according to VAS, EORTC QLQ-CIPN20 scale scores, and quality of life indicators according to SF-36 questionnaire in patients with PPIC on day 20 after the start of clinical intervention. RESULTS. After the conducted course of high-intensity pulsed magnetic therapy there was a significant increase in the cohort of patients with a lower degree of severity of PPIC, the proportion of patients with PPIC belonging to subgroups 0–1 degree of severity increased by 6.6 % (p 0.01). Initial limb pain syndrome according to the VAS system in patients with PPIC in the main group decreased from 6.8 ± 1.2 to 2.4 ± 0.8 points (p 0.05). In the control group VAS changed from 7.0 ± 1.1 to 6.3 ± 0.9 scores (p 0.05), which was not statistically significant. It was found that inclusion of high-intensity pulsed magnetic therapy in the treatment program allows for more significant positive changes in sensory, motor and autonomous-vegetative manifestations of PPIC. According to the SF-36 scale, statistically significant differences were found in relation to physical functioning in patients of the main group. There was also an improvement in the indicators reflecting the social components of the quality of life in patients who received the course effect of (HIPMT) from 61 [58.6; 64.4] points to 66 [59.7; 70.0] points by 8.2 % (p 0.05). Psychological health in the main group improved by 17.02 % (p 0.01). In the control group, there were no significant shifts on any of the scales (p 0.05). CONCLUSION. The use of the high-intensity pulsed magnetic therapy procedures proved to be highly effective in correcting the main indicators of the quality of life of patients with PPIС.

PO031 / #574 HIGH FREQUENCY STIMULATION OF DORSAL COLUMNS AS ALTERNATIVE TREATMENT FOR PHANTOM LIMB PAIN: A CASE REPORT & PROJECTED CASE SERIES: E-POSTER VIEWING

Phantom limb pain syndrome can be a chronic debilitating condition that continues to plague many patients globally. The underlying mechanism has not been fully elucidated or understood. It is likely a complex interplay between the brain, spinal cord and peripheral nociceptors. Despite the prevalence of this condition, there continue to be a scarcity of literature in the pain medicine and neuromodulation ecosystem regarding alternative and effective treatments for the chronic pain arising from this condition.

Phantom limb syndrome: Assessment of psychiatric and medical comorbidities associated with Phantom pain in 44,028 below knee amputees

IntroductionPhantom limb syndrome is a debilitating complication after extremity amputation that poses significant challenges to recovery. This study aims to examine the relationship between phantom limb syndrome and mental and physical comorbidities, including a comparison between phantom limb pain and phantom limb syndrome without pain in below knee amputees. MethodsThis is a retrospective cohort study of patients who underwent below knee amputation of the lower extremity in the PearlDiver database, as identified using CPT codes. Analysis was carried out to evaluate the absence or presence of phantom limb syndrome. Matched bivariate analysis accounting for age, sex, Charlson Comorbidity Index score, and region was used to assess whether the presence of pain in phantom limb syndrome patients was associated with increased comorbidity. ResultsIn total, 44,028 patients with below knee amputation were examined: 95% (42,493 patients) did not develop phantom limb syndrome while 4.8% (1,535 patients) of patients did develop phantom limb syndrome. Phantom limb syndrome was significantly associated with increased odds of coexistent major depressive disorder (OR = 1.86, p <0.0001), generalized anxiety disorder (OR = 2.14, p = 0.04), posttraumatic stress disorder (OR = 1.7, p <0.0001), suicidal ideation (OR = 1.62, p <0.0001), obesity (OR = 1.28, p = 0.0007), osteoarthritis (OR = 1.53, p <0.0001), osteoporosis (OR = 1.64, p <0.0001), and low back pain (OR = 2.31, p <0.0001). Analysis of patient cohorts of phantom limb syndrome with pain and those without pain did not reveal a statistically significant relationship between the presence of pain and any dependent variable. ConclusionsThis investigation of over 44,000 patients with below knee amputation revealed that patients with phantom limb syndrome exhibit significantly higher rate of psychiatric comorbidities compared to those without documented phantom limb pain. Suicidal ideation, major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder were especially common, and consequently a multi-disciplinary approach to management is essential.

Targeted Muscle Reinnervation of the brachial plexus region: A cadaveric study and case series

Targeted Muscle Reinnervation (TMR) has been shown to prevent and treat neuropathic pain as well as enhance bioprosthetic function. A paucity of data and anatomical description exist regarding TMR in the setting of proximal amputations at the level of the brachial plexus region. In this work, the technique and anatomical description of TMR for proximal amputations at the shoulder level and above, with the corresponding brachial plexus nerve transfers and reconstruction, will be described as an anatomic reference and operative guide. Cadaveric dissections of four shoulder and forequarter level amputations were performed. Major mixed motor and sensory nerve branches were identified, dissected, and tagged. Amputated peripheral nerves were then transferred to identified and labeled target motor nerves within the shoulder and chest levels via direct end-to-end coaptations per traditional TMR technique. A retrospective review was completed by our multi-institutional team including clinical case correlates for TMR performed at the described levels. A total of 8 TMR brachial plexus clinical cases were performed between 2016 and 2020 in a primary or secondary setting following oncologic resection or traumatic injuries. Follow-up ranged from 18 to 58 months, mean follow-up of 34.6 months. Six out of 8 patients require no narcotics, while 2 require supplemental narcotic use. One patient requires no pain medication. Four of the 7 patients utilize an EMG enhanced bioprosthetic. The eighth patient died from tumor recurrence. Technical considerations for brachial plexus TMR surgery have been outlined with early follow-up data showing beneficial pain control and prosthetic outcomes. • TMR transfers transected peripheral nerve stumps to redundant motor nerves to prevent formation of symptomatic neuroma. • TMR has been shown to effectively reduce phantom limb pain (PLP) and phantom limb syndrome (PLS). • TMR can be performed on the brachial plexus to act as a bio-amplifier for advanced myoelectric prosthetic use. • With well-performed TMR, minimal re-training is required for use of a future myoelectric prosthesis.

Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used to assess functional use of the prosthesis. The PEQ was used for pain assessment. The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis in the long term follow up.

Classification and Treatment of Sleep Disorders by Clinical Syndrome, Anatomic Localization and Pathophysiology

The treatment of sleep disorders is problematic because the diagnoses consist of an array of unrelated terms, there is little knowledge or link to disease processes, and progression from the patient presentation to effective therapy is not systematic. The purpose of this paper is to provide a coherent framework for understanding sleep disorders, based on anatomy and pathophysiology. A classification of sleep disorders based on classical neurological diagnosis is presented. First, the diagnostic process in classical, clinical neurology is reviewed. In this traditional approach, diagnoses are not inferred directly from symptoms. Rather, symptoms are used to identify putative anatomic localizations, and pathophysiological mechanisms. Diagnoses are inferred as a second step from the localizations and mechanisms of disease. Subsequently, testing may be applied as necessary, using a probabilistic interpretation to guide treatment. Treatment for diseases classified in this manner is more likely to be successful. In addition, be generating alternative hypotheses during this process, if initial treatments are not successful, alternative approaches may be considered. The anatomy and physiology of sleep disorders is briefly reviewed. The process of diagnosis is then presented, starting with specific symptoms, including insomnia, hypersomnia, limb movement disorders, fatigue and pain syndromes. Groups of symptoms, as syndromes, are considered. By relating the symptoms to the localizations and pathophysiology, a more ordered approach to management is presented. The distinction of etiology from diagnosis is discussed. Etiologies that have resolved are typically not treatable. Prior research on fibromyalgia is summarized, including possible anatomic and pathophysiological substrates, and underlying sleep disorders. Other forms of fatigue are contrasted, with implications for different treatments.

Effectiveness of conservative treatment - as the main criterion for determining the duration of domestic disability in elderly patients with complex regional lower limb pain syndrome type I in the outpatient phase of treatment

Effectiveness of conservative treatment - as the main criterion for determining the duration of domestic disability in elderly patients with complex regional lower limb pain syndrome type I in the outpatient phase of treatment

Ketamine for the Treatment of Chronic Pain: A Comprehensive Review.

Chronic pain significantly worsens the quality of life. Unlike neuropathic, musculoskeletal, postoperative pain, and cancer pain, chronic primary pain cannot be explained by an underlying disease or condition, making its treatment arduous. This manuscript intends to provide a comprehensive review of the use of ketamine as a treatment option for specific chronic pain conditions. A review article. A review of the literature. A search was done on PubMed for relevant articles. A comprehensive review of the current understanding of chronic pain and the treatment of specific chronic pain conditions with ketamine. Literature is scarce regarding the use of ketamine for the treatment of chronic pain. First-line treatment for many chronic pain conditions includes NSAIDs, antidepressants, anticonvulsants, and opioids. However, these treatment methods are unsuccessful in a subset of patients. Ketamine has been explored in randomized controlled trials (RCTs) as an alternative treatment option, and it has been demonstrated to improve pain symptoms, patient satisfaction, and quality of life. Conditions highlighted in this review include neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS), phantom limb pain (PLP), cancer pain, and post-thoracotomy pain syndrome. This review will discuss conditions, such as neuropathic pain, fibromyalgia, complex regional pain syndrome, and more and ketamine's efficacy and its supplementary benefits in the chronic pain patient population. As the opioid crisis in the United States continues to persist, this review aims to understand better multimodal analgesia, which can improve how chronic pain is managed.

A Psychometric Platform to Collect Somatosensory Sensations for Neuroprosthetic Use.

Somatosensory neuroprostheses exploit invasive and non-invasive feedback technologies to restore sensorimotor functions lost to disease or trauma. These devices use electrical stimulation to communicate sensory information to the brain. A sensation characterization procedure is thus necessary to determine the appropriate stimulation parameters and to establish a clear personalized map of the sensations that can be restored. Several questionnaires have been described in the literature to collect the quality, type, location, and intensity of the evoked sensations, but there is still no standard psychometric platform. Here, we propose a new psychometric system containing previously validated questionnaires on evoked sensations, which can be applied to any kind of somatosensory neuroprosthesis. The platform collects stimulation parameters used to elicit sensations and records subjects' percepts in terms of sensation location, type, quality, perceptual threshold, and intensity. It further collects data using standardized assessment questionnaires and scales, performs measurements over time, and collects phantom limb pain syndrome data. The psychometric platform is user-friendly and provides clinicians with all the information needed to assess the sensory feedback. The psychometric platform was validated with three trans-radial amputees. The platform was used to assess intraneural sensory feedback provided through implanted peripheral nerve interfaces. The proposed platform could act as a new standardized assessment toolbox to homogenize the reporting of results obtained with different technologies in the field of somatosensory neuroprosthetics.

Compliant Prosthetic Wrists Entail More Natural Use Than Stiff Wrists During Reaching, Not (Necessarily) During Manipulation.

Developing an artificial arm with functions equivalent to those of the human arm is one of the challenging goals of bioengineering. State-of-the-artprostheses lack several degrees of freedom and force the individuals to compensate for them by means of compensatory movements, which often result in residual limb pain and overuse syndromes. Passive wristsmay reduce such compensatory actions, nonethelessto date their actual efficacy, associated to conventional myoelectric hands is a matter of debate. We hypothesized that a transradial prosthesiswould allow a simpler operation if its wrist behaved compliant during the reaching and grasping phase, and stiff during the holding andmanipulation phase. To assess this, we compared a stiff and a compliant wrist and evaluating the extent of compensatory movements in the trunk and shoulder, with unimpaired subjects wearing orthoses, while performing nine activities of daily living taken from the southampton hand assessment procedure. Our findings show indeed that the optimal compliance for a prosthetic wrist is specific to the phase of the motor task: the compliant wrist outperforms the stiff wrist during the reaching phase, whereas the stiff wrist exhibits more natural movements during the manipulation phase of heavy objects. Hence, this paper invites rehabilitation engineers to develop wrists with switchable compliance.

Levorphanol for Treatment of Intractable Neuropathic Pain in Cancer Patients.

Neuropathic pain in cancer patients is often difficult to treat, requiring a combination of several different pharmacological therapies. We describe two patients with complex neuropathic pain syndromes in the form of phantom limb pain and Brown-Sequard syndrome who did not respond to conventional treatments but responded dramatically to the addition of levorphanol. Levorphanol is a synthetic strong opioid that is a potent N-methyl-d-aspartate receptor antagonist, mu, kappa, and delta opioid receptor agonist, and reuptake inhibitor of serotonin and norepinephrine. It bypasses hepatic first-pass metabolism and thereby not subjected to numerous drug interactions. Levorphanol's unique profile makes it a potentially attractive opioid in cancer pain management.

Neuromonitoring for Spinal Cord Stimulation Lead Placement Under General Anesthesia.

Spinal cord stimulation (SCS) is a common therapeutic technique for treating medically refractory neuropathic back and other limb pain syndromes. SCS has historically been performed using a sedative anesthetic technique where the patient is awakened at various times during a surgical procedure to evaluate the location of the stimulator lead. This technique has potential complications, and thus other methods that allow the use of a general anesthetic have been developed. There are two primary methods for placing leads under general anesthesia, based on 1) compound muscle action potentials and 2) collisions between somatosensory evoked potentials. Both techniques are discussed, and the literature on SCS lead placement under general anesthesia using intraoperative neurophysiological mapping is comprehensively reviewed.

Prevalence of Specific Types of Pain Diagnoses in a Sample of United States Adults

Background: Patients with pain conditions place significant demands on health care services globally. Health economists have reported the annual economic cost of pain in the United States as high as $635 billion. A common challenge in treating patients suffering from chronic pain conditions is accurate diagnosis and treatment. Objective: The aim of this study was to determine the modern-day prevalence of individual types of pain diagnoses in adults. Study Design: Retrospective analysis of Truven MarketScan® Commercial and Medicare Supplemental database. Setting: United States patient population with pain diagnoses from 2000 to 2012. Methods: Multivariate analysis was used to determine the individual prevalence of specific types of pain diagnoses over a 13-year period. We grouped the 6,575,999 patients with ICD-9 pain diagnoses into pain groupings. Results: We determined the prevalence of pain groupings as back pain (74.7%), chronic pain (10.4%), complex regional pain syndrome (1.2%), degenerative spine disease (63.6%), limb pain (50.0%), neuritis/radiculitis (52.8%), and post-laminectomy syndrome (14.8%). Limitations: Retrospective and non-randomized study with a patient cohort that is weighted towards recent years and commercial insurance. Coding discrepancies that are recorded and collected for patients. Conclusions: The demographic differences and similarities within the subgroups highlight that pain diagnoses should be considered as separate, but related entities. The present study helps us to better understand the frequency of specific pain diagnoses, and directs future studies to appropriately focus on pain diagnoses based on prevalence. This will allow increased understanding of the variation in pain diagnoses and prevent over-generalization in studies examining pain patients to more accurately reflect the varied subtypes and their economic impact. Duke University Institutional Review Board Protocol: 00053624 Key words: Pain diagnoses, CRPS, neuritis, radiculitis, limb pain, degenerative spine disease, back pain, chronic pain, post-laminectomy pain, prevalence, MarketScan

Chronic pain : Perception, reward and neural processing

Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.

Adhesive capsulitis: An age related symptom of metabolic syndrome and chronic low-grade inflammation?

Adhesive capsulitis (AC) is very poorly understood, particularly it’s underlying etiology. Obesity and metabolic syndrome, which are strongly associated with chronic low grade inflammation, are becoming increasingly understood to underlie a raft of morbid states including upper limb pain syndromes, diabetes (DM), cardiovascular disease (CVD), cancer and central nervous system dysfunction and degeneration. Notwithstanding age, two of the strongest established risk factors for AC are DM and CVD. The hypothesis argues that similar to DM and CVD, the inflammation and capsular fibrosis seen in AC is precipitated by metabolic syndrome and chronic low grade inflammation. These pathophysiological mechanisms are highly likely to be perpetuated by upregulation of pro-inflammatory cytokine production, sympathetic dominance of autonomic balance, and neuro-immune activation. The hypothesis predicts and describes how these processes may etiologically underpin and induce each sub-classification of AC. An improved understanding of the etiology of AC may lead to more accurate diagnosis, improved management, treatment outcomes, and reduce or prevent pain, disability and suffering associated with the disease. The paper follows on with a discussion of similarities between the pathophysiology of AC to general systemic inflammatory control mechanisms whereby connective tissue (CT) fibrosis is induced as a storage depot for leukocytes and chronic inflammatory cells. The potential role of hyaluronic acid (HA), the primary component of the extracellular matrix (ECM) and CT, in the pathophysiology of AC is also discussed with potential treatment implications. Lastly, a biochemical link between physical and mental health through the ECM is described and the concept of a periventricular-limbic central driver of CT dysfunction is introduced.

Manejo del síndrome doloroso del miembro fantasma en niños amputados por cáncer: un enfoque integral

The purpose of this review was drawn from literature recommendations for the management of phantom limb pain in children having cancer-related amputation, summarized in a comprehensive approach.The phantom limb pain syndrome occurs in 48 to 80% of amputees, causes deterioration of the quality of life, increased health care costs and hinders their rehabilitation. The pathophysiology of this clinical entity includes the interaction of peripheral mechanisms and abnormal processing of the information in the central nervous system.Its management requires intervention strategies focused on prevention and early treatment. Pharmacological options include gabapentinoids, opioids and anti NMDA. In conclusion, there is no consensus on management. Key points include optimal pain control before surgery, managing multidisciplinary pain clinic, mental health, social work and rehabilitation as standard of care in amputees. Evidence levelIV.

Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation.

Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP) results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life. Subjects suffering from NP describe it as burning, itching, lancing, and numbness, but hyperalgesia and allodynia represent the most bothersome symptoms. The management of NP is a clinical challenge and several non-pharmacological and pharmacological interventions have been proposed with variable benefits. Botulinum toxin (BTX) as an adjunct to other interventions can be a useful therapeutic tool for the treatment of disabled people. Although BTX-A is predominantly used to reduce spasticity in a neuro-rehabilitation setting, it has been used in several painful conditions including disorders characterized by NP. The underlying pharmacological mechanisms that operate in reducing pain are still unclear and include blocking nociceptor transduction, the reduction of neurogenic inflammation by inhibiting neural substances and neurotransmitters, and the prevention of peripheral and central sensitization. Some neurological disorders requiring rehabilitative intervention can show neuropathic pain resistant to common analgesic treatment. This paper addresses the effect of BTX-A in treating NP that complicates frequent disorders of the central and peripheral nervous system such as spinal cord injury, post-stroke shoulder pain, and painful diabetic neuropathy, which are commonly managed in a rehabilitation setting. Furthermore, BTX-A has an effect in relief pain that may characterize less common neurological disorders including post-traumatic neuralgia, phantom limb, and complex regional pain syndrome with focal dystonia. The use of BTX-A could represent a novel therapeutic strategy in caring for neuropathic pain whenever common pharmacological tools have been ineffective. However, large and well-designed clinical trials are needed to recommend BTX-A use in the relief of neuropathic pain.

Is it Finger or Wrist Dexterity That is Missing in Current Hand Prostheses?

Building prostheses with dexterous motor function equivalent to that of the human hand is one of the ambitious goals of bioengineers. State of art prostheses lack several degrees of freedom (DoF) and force the individuals to compensate for them by changing the motions of their arms and body. However, such compensatory movements often result in residual limb pain and overuse syndromes. Significant efforts were spent in designing artificial hands with multiple allowed grasps but little work has been done with regards to wrist design, regardless the fact that the wrist contributes significantly to the execution of upper limb motor tasks. We hypothesized that a single DoF hand with wrist flexion/extension allowed function comparable to a highly performant multi DoF hand without wrist flexion/extension. To assess this we compared four emulated architectures of hand-wrist prostheses using the Southampton Hand Assessment Procedure and evaluating the extent of compensatory movements with unimpaired subjects wearing ortheses. Our findings show indeed that shifting the dexterity from the hand to the wrist could preserve the ability of transradial amputees in performing common tasks with limited effect on the compensatory movements. Hence, this study invites rehabilitation engineers to focus on novel artificial wrist architectures.

ОШИБКИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ВЕРТЕБРОГЕННОГО ШЕЙНОГО КОРЕШКОВОГО КОМПРЕССИОННОГО СИНДРОМА И ПСЕВДОРАДИКУЛЯРНЫХ БРАХИАЛГИЙ

Objective. To analyze adverse outcomes of surgical treatment of radicular compression syndrome and to present an algorithm for diagnosis and differential treatment of radicular and pseudoraducular brachialgias. Material and Methods. The catamneses of 60 patients hospitalized for adverse outcome of previous surgery for cervical radicular compression syndrome were studied. Analysis of errors and developed algorithm for diagnosis and differential treatment of upper limb pain syndromes facilitated the prospective study of 350 patients with pseudoradicular brachialgia caused by pathological impulses from the affected intervertebral discs and facet joints. Results. Stable regression of pseudoradicular arm pain was achieved in 94 % of patients. Disc puncture reproduction of patient’s specific arm pain and its elimination by means of chemical denervation confirmed the dependence of this pain mainly on degenerative disc disease in 33.8 % of cases, on spondylarthrosis in 6.7 %, and equally on degenerative disc disease and spondylarthrosis in 59.5 %. Conclusion. The developed algorithm for diagnosis and differentiated treatment of upper limb pain syndromes depending on the combination of different pathomorphological substrates and syndromes can improve the results of treatment in patients with brachialgia and achieve stable regression of pseudoradicular pain.