Nerve resection for the treatment of chronic neuropathic pain

When empirical observations fly in the face of prior knowledge, it is likely that there are lessons to be learned. Peter Watson and coauthors report in this issue of PAIN® a case of a young woman with chronic debilitating complex regional pain syndrome (CRPS) 2 resulting from traumatic nerve injury in the ankle, exacerbated by a subsequent orthopedic procedure. Typical of CRPS, the pain spread beyond the ankle, resulting in severe burning pain and tactile allodynia on most of the lower leg. A variety of pharmacologic, physical, and psychological therapies failed to relieve the pain. After 13years of suffering by the patient (and frustration by her physicians), the unusual step was taken to cut some of the nerves serving the injured ankle. According to the report, this surgery resulted in an immediate and dramatic improvement in the allodynia and associated neuropathic pain symptoms, which has so far lasted >2years. There remains, however, a qualitatively different (and arguably nonneuropathic) residual ankle soreness which severely limits mobility.
Source: Pain - Category: Anesthesiology Authors: Tags: Commentaries Source Type: research