Treatment Of Chronic Neuropathic Pain Research Articles

Relationship between Patient-reported Outcome Measures and Accelerometer-measured Physical Activity and Sleep in Patients with Post-herpetic Neuralgia.

Available treatment for chronic neuropathic pain is still limited, and the effect is modest. Thus, clinicians aim to improve activity and quality of life despite pain. The objective monitoring of activity is attracting attention in chronic pain assessments. Therefore, we objectively evaluated daytime activity and sleep in patients with post-herpetic neuralgia, using actigraphy to determine risk factors for decreased activity. Patients with post-herpetic neuralgia wore an actigraph (a wristwatch-like accelerometer) on the non-dominant hand. The actigraph measured day-time activity and sleep, which were compared with patient-reported subjective pain and sleep assessments. Fifty-four patients with post-herpetic neuralgia who visited our outpatient clinic completed questionnaires and a week of actigraph monitoring. Subjective scores of pain intensity, neuropathic pain, disability in daily life, pain-catastrophizing thoughts, and insomnia were all well correlated. However, the actigraph-monitored activity levels, using two equations, and sleep quality were not associated with any pain- or sleep-related subjective scores. The discrepancy between the subjective and objective scores in this study may be due to 1) features of post-herpetic neuralgia, an archetype of peripheral neuropathic pain affecting no motor nerves, 2) actigraph measurement limitations regarding the sedentary life of the elderly, or 3) activity misperception, a new proposition explaining the discrepancy between subjective and objective measures of activity, similar to the sleep state misperception. In patients with post-herpetic neuralgia, high pain intensity may be reported in those with highly maintained activity, in which treatment must be selected cautiously to prevent interruption of their physical abilities.

The use of low doses of gabapentin in patients with neuropathic pain and with thrombocytopenia

Introduction. Approximately 21–27% of patients with blood system diseases receive opioid analgesics, with neuropathic pain being one of the most common reasons for prescription. Gabapentin is used as a first-line drug for neuropathic pain (NP), but has been poorly studied in patients with blood system diseases.The objective was to study the effectiveness and safety of gabapentin in patients with blood system diseases with chronic pain.Materials and methods. A single-center, prospective observational study included 24 patients with thrombocytopenia and pain between October 2017 and October 2022. The patients’ age ranged from 18 to 71 years (median 40 years). All patients with blood system diseases: non-tumor blood system diseases (aplastic anemia) in 8% (n = 2), myeloid tumor blood system diseases (acute myeloid leukemia) in 34% (n = 8), lymphoid tumor blood system diseases (acute lymphoblastic leukemia, follicular lymphoma, diffuse B – large cell lymphoma, T-cell lymphomas, multiple myeloma) in 58% (n = 14). All patients had thrombocytopenia less than 150∙109/l, 66% (n = 16) had less than 90∙109/l. All patients were diagnosed with neuropathic pain (NP), localized according to the neuroanatomical distribution and accompanied by sensory disturbances typical of NP. The localization of pain was different, pain predominated in the lower extremities (63% (n = 15), 95% CI: 43 – 79%), caused by peripheral polyneuropathy of predominantly toxic origin (vincristine, bortezomib), and pain was also caused by the course of the underlying disease: cephalalgia and neck pain, this pain was caused by compression of the nerve structures by the lymph nodes, postherpetic neuralgia, trigeminal neuralgia caused by tumor growth. All patients had intractable, high-intensity pain requiring trimeperidine at a dose of 20–40 mg/day. All patients were prescribed gabapentin therapy at a dose of 900–1200 mg/day.Results. When taking gabapentin in the study group of patients (n = 24), already on the 3rd day, there was a clinically and statistically significant decrease in pain intensity: 1) by median: from the initial 6 to 4 points, p = 0.01 (and up to 3 points by 7th day of therapy) and 2) on average: from initial 6.5 to 3.9 points, p = 0.01 (and up to 3.2 points by the 7th day). Stratification of the dynamics of pain intensity reduction by type of blood system disease (BSD) shows that the decrease by day 3 (sustained and further by day 7) was clinically and statistically significant (p = 0.01) for groups of patients with lymphoid and myeloid BSD, and clinically and approximately statistically significant in patients (n = 2) with non-tumor BSD. Analgesic therapy using small doses of gabapentin gave a pronounced, stable positive effect (pain intensity statistically significantly decreased by an average of 50%). After 7 days of gabapentin therapy, a decrease in the opioid dose was noted in 52% of patients. Side effects were dominated by drowsiness 67% (n = 16), dizziness 32% (n = 8).Conclusion. The results of this study indicate that gabapentin is effective in the treatment of chronic neuropathic pain in patients with BSD and is safe when used in minimal/average therapeutic doses within the daily dosing ranges established by the official instructions for use.

Peripheral Nerve Stimulation of the Shoulder: A Technical Primer.

Scapulalgia or shoulder pain accounts for 16% of all musculoskeletal complaints in the healthy adult population and becomes more common as we age. When this pain exceeds 3 months in duration, it is deemed to be chronic, and typically treated in an escalating manner. Spanning a continuum of conservative and non-conservative measures, chronic shoulder pain treatments range from rest and physical therapy to surgery. Since each patient presents with a unique spectrum of symptoms a customized treatment plan is often required. Over the lifetime of many of these patients, a variety of treatment options are required. One of these treatment options, peripheral nerve stimulation (PNS), is a minimally invasive procedure in which an electrical impulse is delivered through a percutaneously implanted, small caliber electrode to a peripheral nerve proximal to the lesion which interferes with the pain signals. Over the past several years, significant growth of PNS in the treatment of chronic neuropathic pain has been observed. However, the procedural techniques have not been well described. The foundation of long-term, minimally invasive percutaneous PNS in patients with chronic shoulder pain, and procedural techniques for stimulating the suprascapular and axillary nerves using fluoroscopy or ultrasonography will be described in this report.

Different genes involved in the amelioration of chronic neuropathic pain and comorbid anxiety by electroacupuncture with different intensities

BackgroundWith its complex and prevalent symptoms, chronic neuropathic pain (CNP) is frequently combined with negative emotions. Electroacupuncture (EA) is a widely-used and effective treatment for CNP and pain-induced comorbid anxiety-like behaviors (PABs). Although different effects may result from EA with different intensities, the underlying mechanisms remain unclear. ObjectiveThe study aimed to investigate the effects of EA with different intensities on CNP and PABs and the underlying mechanisms, by exploring the different genes through RNASeq in the spinal cord dorsal horn (SCDH) and periaqueductal gray (PAG). MethodsA spared nerve injury (SNI) model was established using male C57BL/6 J mice, and treated with EA of different intensities (0.1 mA or 0.3 mA, both at 100 Hz). The von-Frey tests, open field tests and elevated plus maze tests were used to measure the mechanical paw withdrawal threshold (PWT) and PABs of the mice. The tissues of SCDH and PAG regions were extracted to identify the changes in gene expression, and biofunctional analysis of differentially expressed genes (DEGs) was further performed by RNA-seq analysis. The expression of key DEGs and corresponding proteins was assessed using quantitative real-time PCR (qPCR) and protein immunofluorescence detection, respectively. ResultsBoth 0.1 mA and 0.3 mA EA at 100 Hz alleviated PABs compared with the SNI group. Furthermore, 0.3 mA EA was effective in increasing PWT in SNI mice, whereas 0.1 mA EA was not. A total of 108 DEGs was identified in the SCDH, and 254 DEGs were identified in the PAG. Specifically, the expression of Tnr in SNI mice decreased after the treatment with 0.3 mA EA at 100 Hz, and the expression of Ptprb, Net1, Abcb1a and Adgrf5 in SNI mice decreased in the PAG after the treatment with 0.1 mA EA at 100 Hz. ConclusionThe effect of 0.3 mA EA on chronic pain may be related to the decrease of Tnr expression in SCDH, and the effect of 0.1 mA EA on PABs may be achieved by decreased expression of Ptprb and Net1 in PAG.

Rational Design of Potent α-Conotoxin PeIA Analogues with Non-Natural Amino Acids for the Inhibition of Human α9α10 Nicotinic Acetylcholine Receptors.

α-Conotoxins (α-CTxs) are structurally related peptides that antagonize nicotinic acetylcholine receptors (nAChRs), which may serve as new alternatives to opioid-based treatment for pain-related conditions. The non-natural amino acid analogues of α-CTxs have been demonstrated with improved potency compared to the native peptide. In this study, we chemically synthesized Dab/Dap-substituted analogues of α-CTx PeIA and evaluated their activity at heterologously expressed human α9α10 nAChRs. PeIA[S4Dap, S9Dap] had the most potent half-maximal inhibitory concentration (IC50) of 0.93 nM. Molecular dynamic simulations suggested that the side chain amino group of Dap4 formed additional hydrogen bonds with S168 and D169 of the receptor and Dap9 formed an extra hydrogen bond interaction with Q34, which is distinctive to PeIA. Overall, our findings provide new insights into further development of more potent analogues of α-CTxs, and PeIA[S4Dap, S9Dap] has potential as a drug candidate for the treatment of chronic neuropathic pain.

Regenerative Peripheral Nerve Interface Surgery for the Management of Chronic Posttraumatic Neuropathic Pain.

Chronic pain resulting from peripheral nerve injury remains a common issue in the United States and affects 7 to 10% of the population. Regenerative Peripheral Nerve Interface (RPNI) surgery is an innovative surgical procedure designed to treat posttraumatic neuropathic pain, particularly when a symptomatic neuroma is present on clinical exam. RPNI surgery involves implantation of a transected peripheral nerve into an autologous free muscle graft to provide denervated targets to regenerating axons. RPNI surgery has been found in animal and human studies to be highly effective in addressing postamputation pain. While most studies have reported its uses in the amputation patient population for the treatment of neuroma and phantom limb pain, RPNI surgery has recently been used to address refractory headache, postmastectomy pain, and painful donor sites from the harvest of neurotized flaps. This review summarizes the current understanding of RPNI surgery for the treatment of chronic neuropathic pain.

Conversion of a medical implant into a versatile computer-brain interface

BackgroundInformation transmission into the human nervous system is the basis for a variety of prosthetic applications. Spinal cord stimulation (SCS) systems are widely available, have a well documented safety record, can be implanted minimally invasively, and are known to stimulate afferent pathways. Nonetheless, SCS devices are not yet used for computer-brain-interfacing applications. ObjectiveHere we aimed to establish computer-to-brain communication via medical SCS implants in a group of 20 individuals who had been operated for the treatment of chronic neuropathic pain. MethodsIn the initial phase, we conducted interface calibration with the aim of determining personalized stimulation settings that yielded distinct and reproducible sensations. These settings were subsequently utilized to generate inputs for a range of behavioral tasks. We evaluated the required calibration time, task training duration, and the subsequent performance in each task. ResultsWe could establish a stable spinal computer-brain interface in 18 of the 20 participants. Each of the 18 then performed one or more of the following tasks: A rhythm-discrimination task (n = 13), a Morse-decoding task (n = 3), and/or two different balance/body-posture tasks (n = 18; n = 5). The median calibration time was 79 min. The median training time for learning to use the interface in a subsequent task was 1:40 min. In each task, every participant demonstrated successful performance, surpassing chance levels. ConclusionThe results constitute the first proof-of-concept of a general purpose computer-brain interface paradigm that could be deployed on present-day medical SCS platforms.

Low-Energy Transcranial Navigation-Guided Focused Ultrasound for Neuropathic Pain: An Exploratory Study.

Neuromodulation using high-energy focused ultrasound (FUS) has recently been developed for various neurological disorders, including tremors, epilepsy, and neuropathic pain. We investigated the safety and efficacy of low-energy FUS for patients with chronic neuropathic pain. We conducted a prospective single-arm trial with 3-month follow-up using new transcranial, navigation-guided, focused ultrasound (tcNgFUS) technology to stimulate the anterior cingulate cortex. Eleven patients underwent FUS with a frequency of 250 kHz and spatial-peak temporal-average intensity of 0.72 W/cm2. A clinical survey based on the visual analog scale of pain and a brief pain inventory (BPI) was performed during the study period. The average age was 60.55 ± 13.18 years-old with a male-to-female ratio of 6:5. The median current pain decreased from 10.0 to 7.0 (p = 0.021), median average pain decreased from 8.5 to 6.0 (p = 0.027), and median maximum pain decreased from 10.0 to 8.0 (p = 0.008) at 4 weeks after treatment. Additionally, the sum of daily life interference based on BPI was improved from 59.00 ± 11.66 to 51.91 ± 9.18 (p = 0.021). There were no side effects such as burns, headaches, or seizures, and no significant changes in follow-up brain magnetic resonance imaging. Low-energy tcNgFUS could be a safe and noninvasive neuromodulation technique for the treatment of chronic neuropathic pain.

Identification and targeting of a unique NaV1.7 domain driving chronic pain

Small molecules directly targeting the voltage-gated sodium channel (VGSC) NaV1.7 have not been clinically successful. We reported that preventing the addition of a small ubiquitin-like modifier onto the NaV1.7-interacting cytosolic collapsin response mediator protein 2 (CRMP2) blocked NaV1.7 function and was antinociceptive in rodent models of neuropathic pain. Here, we discovered a CRMP2 regulatory sequence (CRS) unique to NaV1.7 that is essential for this regulatory coupling. CRMP2 preferentially bound to the NaV1.7 CRS over other NaV isoforms. Substitution of the NaV1.7 CRS with the homologous domains from the other eight VGSC isoforms decreased NaV1.7 currents. A cell-penetrant decoy peptide corresponding to the NaV1.7-CRS reduced NaV1.7 currents and trafficking, decreased presynaptic NaV1.7 expression, reduced spinal CGRP release, and reversed nerve injury-induced mechanical allodynia. Importantly, the NaV1.7-CRS peptide did not produce motor impairment, nor did it alter physiological pain sensation, which is essential for survival. As a proof-of-concept for a NaV1.7 -targeted gene therapy, we packaged a plasmid encoding the NaV1.7-CRS in an AAV virus. Treatment with this virus reduced NaV1.7 function in both rodent and rhesus macaque sensory neurons. This gene therapy reversed and prevented mechanical allodynia in a model of nerve injury and reversed mechanical and cold allodynia in a model of chemotherapy-induced peripheral neuropathy. These findings support the conclusion that the CRS domain is a targetable region for the treatment of chronic neuropathic pain.

Efficacy of Lidocaine Infusion for Treatment of Chronic Neuropathic Pain: A Case Control Study

Background: Neuropathic pain is a type of chronic pain that is related to nerve damage and is defined by the International Association of Study of Pain (IASP) as “pain caused by a disease or lesion of the somatosensory nervous system”. It remains a challenging clinical problem as pain often can be quite severe and debilitating. The rationale of this study is to find out the efficacy of intravenous lidocaine infusion for neuropathic pain management in our population as there has been no study conducted in Pakistan for this purpose. As our country has a rather low-income population and cheaper options for treatment need to be explored. Objective: To determine the efficacy of lidocaine infusions of 3 mg/kg in managing the chronic neuropathic pain given at 0,1, 2 and 3 weeks in comparison to the placebo infusion. Study Design: Case control study. Settings: The study was conducted in the Sheikh Zayad Hospital Lahore Pakistan. Duration: July 2022 to December 2022. Methods: 100 outdoor patients fulfilling the inclusion and exclusion criteria were enrolled after taking informed written consent and were randomly allocated to Lidocaine group (A) 3 mg/kg, diluted in 50 ml normal saline and placebo group (B) 50 ml intravenously over 30 minutes. The Lidocaine group was injected with lidocaine, intravenously over 30 minutes once a week for 4 weeks. Patients with established diagnosis of neuropathic pain, adults of both genders, age above 18 years were enrolled in this study. Their pain severity was recorded using Numerical rating scale (NRS). The data of both groups was recorded in predesigned proforma and efficacy was also noted as labelled as Yes/No for two points; 1: Decrease in pain score by at least 2 out of 10 and 2: Decrease in oral analgesics intake. Results: There were 50 patients in group A and B with the mean age of 53.82 years and 54.4 years respectively. Patients in group A who received an intravenous infusion of lidocaine reported less severe pain and fewer instances of breakthrough pain. No statistically significant difference (P>0.05) was discovered between NRS ratings before and after infusions in the control group despite the fact that several patients reported lower pain intensity after the infusion. The quantity of opioid used was determined for the Lidocaine and Placebo groups. Opioid in the placebo group was 0.472–0.572 g per patient, but in the Lido group it was only 0.1–0.2 g per patient which is significantly different from placebo group (p=0.0021). Conclusion: Lidocaine intravenous infusion (3 mg/kg daily for 4 weeks) improved short-term results of therapy, decreased the need for analgesic medication, and shortened pain score without causing major adverse effects.

ID: 217176 Conus Medullaris Stimulation Versus Thoracic Spinal Cord Stimulation for the Management of Chronic Pelvic Pain

While spinal cord stimulation has been well studied for the treatment of chronic neuropathic pain for the upper and lower extremities, few reports exist for the utility of spinal cord stimulation for the management of chronic pelvic pain. Furthermore, of the studies that describe spinal cord stimulation for pelvic pain, few are able to effectively compare the efficacy of thoracic spinal cord stimulation versus other stimulation modalities in the same patient. Pelvic sympathetic viscera are innervated by fibers at T12-L2 roots, while parasympathetic roots are at S1-S4. Evidence suggests that pelvic pain is well covered with conus stimulation as it captures the S2-S5 segment.

ID: 222688 Functional Ultrasound Imaging Reveals Activation Properties of Clinical Spinal Cord Stimulation Therapy

Spinal cord stimulation (SCS) therapy has long been established as an effective treatment for chronic neuropathic pain. However, methodological limitations have prohibited the detailed investigation of the activation patterns produced in the spinal cord during therapy. Functional ultrasound (fUS) is an emerging technology that monitors local hemodynamic changes in the brain that are tightly coupled to neural activity1-3. Previous studies have demonstrated that the high spatiotemporal resolution of fUS can be used to monitor activation in the spinal cord during SCS4,5. In this study, fUS was used to investigate neuromodulation patterns produced by clinical SCS paradigms in an ovine model that enabled testing with implanted clinical hardware.

Machine Learning in Spinal Cord Stimulation for Chronic Pain.

Spinal cord stimulation (SCS) is an effective treatment for chronic neuropathic pain. The success of SCS is dependent on candidate selection, response to trialing, and programming optimization. Owing to the subjective nature of these variables, machine learning (ML) offers a powerful tool to augment these processes. Here we explore what work has been done using data analytics and applications of ML in SCS. In addition, we discuss aspects of SCS which have narrowly been influenced by ML and propose the need for further exploration. ML has demonstrated a potential to complement SCS to an extent ranging from assistance with candidate selection to replacing invasive and costly aspects of the surgery. The clinical application of ML in SCS shows promise for improving patient outcomes, reducing costs of treatment, limiting invasiveness, and resulting in a better quality of life for the patient.

Neuromodulation in the treatment of chronic neuropathic pain and neurodegenerative diseases

Finding ways to treat chronic neuropathic pain and neurodegenerative diseases has been plaguing scientists for a long time. Pharmacological methods were firstly used to deal with these diseases. However, problems like drug overdose and addiction largely limit the efficacy of pharmacological treatment. With the rapid development of electronic devices and materials, scientists now have the ability to modulate nerve activities in a different way. Neuromodulation is a boosting field of neurotechnology which use physical or chemical methods to exert modulation effects in the central or peripheral nervous system of the human body. Usually, neuromodulation is used as an alternative to long-term drug therapy for treating chronic neuropathic pain. This article discusses the mechanisms and methods of neuromodulation and reviews its applications in neuropathic pain, Alzheimer’s, and Parkinson’s. Different methods of neuromodulation are put together and their characteristics and advantages are discussed. This article provides a reference to current neuromodulation technics, their possible mechanisms, and applications, helping future studies gain a clear overview of the field of neuromodulation.

Long-term efficacy of spinal cord stimulation for chronic primary neuropathic pain in the contemporary era: a systematic review and meta-analysis.

Spinal cord stimulation (SCS) is a modern neuromodulation technique extensively proven to be an effective modality for treatment of chronic neuropathic pain. It has been mainly studied for complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS) and recent data almost uniformly establishes its statistically significant positive therapeutic results. It has also been compared with other available treatment modalities across various studies. However, long term data on maintenance of its efficacious potential remains less explored. Few studies have reported data on long follow-up times (>= 12 months) and have compared its efficacy with other treatment options for chronic pain, respectively. Our study pools and analyzes the available data and compares SCS with other treatment options. It also analyzes the efficacy of SCS in long term management of patients with chronic pain. We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS. According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months. SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.

N-type calcium channel blockers: a new approach towards the treatment of chronic neuropathic pain

Neuropathic pain (NP) remains maltreated for a wide number of patients by the currently available treatments and little research has been done in finding new drugs for treating NP. Ziconotide (PrialtTM) had been developed as the new drug, which belongs to the class of ω-conotoxin MVIIA. It inhibits N-type calcium channels. Ziconotide is under the last phase of the clinical trial, a new non-narcotic drug for the management of NP. Synthetically it has shown the similarities with ω-conotoxin MVIIA, a constituent of poison found in fish hunting snails (Conus magus). Ziconotide acts by selectively blocking neural N-type voltage-sensitized Ca2+ channels (NVSCCs). Certain herbal drugs also have been studied but no clinical result is there and the study is only limited to preclinical data. This review emphasizes the N-type calcium channel inhibitors, and their mechanisms for blocking calcium channels with their remedial prospects for treating chronic NP.

Test-retest reliability of a simple bedside-quantitative sensory testing battery for chronic neuropathic pain.

The sensory phenotype is believed to provide information about the underlying pathophysiological mechanisms and to be used in the diagnosis and treatment of chronic neuropathic pain. However, the use of standardized quantitative sensory testing (QST) protocols is limited due to high expenditures of time and costs. Thus, a simple bedside-QST battery was recently developed showing good agreement when compared with laboratory QST. The aim of this study was to preliminary validate this bedside-QST protocol. Patients experiencing chronic pain with neuropathic features (n = 60) attended 3 visits. During the first visit, laboratory QST and bedside-QST were performed by the same trained investigator. Three hours and 3 weeks later, bedside-QST was repeated. Patients completed questionnaires regarding their pain (intensity, quality), depression/anxiety, and quality of life. Test-retest reliability and convergent/divergent validity were investigated. Most of the bedside-QST parameters, including also those recommended in our first study as being indicative for sensory phenotypes, revealed a moderate to excellent test-retest reliability. Overall, results for short-term reliability and interval-scaled parameters were slightly better. Most of the bedside-QST parameters did not correlate with the depression and anxiety score, suggesting a good divergent validity. Bedside-QST has good criterion and divergent validity as well as reliability. This battery consists of 5 low-cost devices that can be quickly and easily used to characterize the sensory phenotype of patients with neuropathic pain. A combination of bedside-QST parameters can be used to investigate patients' subgroups with specific pathophysiological mechanisms and to identify treatment responders.

Study on structure-activity relationship (SAR) of simplified mirogabalin derivatives as voltage-gated calcium channel α2δ ligands for the treatment of chronic neuropathic pain

Study on structure-activity relationship (SAR) of simplified mirogabalin derivatives as voltage-gated calcium channel α2δ ligands for the treatment of chronic neuropathic pain

EE518 An Early Cost-Effectiveness Analysis of Minimally Invasive Paddle-Type Spinal Cord Stimulation for the Treatment of Chronic Neuropathic Pain

EE518 An Early Cost-Effectiveness Analysis of Minimally Invasive Paddle-Type Spinal Cord Stimulation for the Treatment of Chronic Neuropathic Pain

Multiple Concurrent Decompressions for the Treatment of Upper Extremity Pain

Neuropathic pain can be life altering and difficult to treat. Nerves can be compressed along their path in the upper extremities, resulting in chronic neuropathic pain. This study was performed to evaluate the effectiveness and safety of multiple concomitant distal nerve decompressions for the treatment of upper extremity nerve pain. A retrospective review of patients from a single surgeon's academic practice was performed to identify those undergoing nerve decompressions for an indication of "pain" as the referring diagnosis between April 2020 and June 2021. The primary outcomes included patient-reported severity of pain using the Visual Analog Scale and quality-of-life measures, including level of frustration, depression, and impact on quality of life attributable to pain on a similar 0-10 Likert scale. Complications, if any, were also determined. Eleven patients were identified to have undergone multiple concurrent nerve decompressions for the indication of upper extremity pain. All sites chosen for decompression were found to be provocative, ie, elicited increased pain on examination with compression. The median number of decompressions performed was 5 (interquartile range, 4-6), ranging from 3 to 7. The mean follow-up time was 5 months (SD, 3.43 months). The average pain over the last month and the average pain over the past week had significant improvement at the final follow-up, and there was a statistically significant decrease in the patient-reported mean impact of pain on quality of life following decompressions (preoperative, 5.8; postoperative, 3.6; P= .017; 95% confidence interval, 0.2-4.3). No complications were identified. Performing multiple concomitant nerve decompressions of the upper extremities is safe and effective in the treatment of chronic neuropathic pain following upper extremity trauma. Therapeutic IV.