Minim Invasive Neurosurg 2000; 43(1): 44-50
DOI: 10.1055/s-2000-8413
ORIGINAL PAPER
Georg Thieme Verlag Stuttgart · New York

Augmentative Treatment of Chronic Deafferentation Pain Syndromes after Peripheral Nerve Lesions

H. Ebel, A. Balogh1 , M. Volz, N. Klug
  • Neurosurgical Department, University of Cologne, Germany
  • 1 Neurosurgical Department, University of Debrecen, Hungary
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Dezember 2000 (online)

Deafferentation pain syndromes developing after peripheral nerve lesions are difficult to treat. According to the follow-up (mean: 39.5 months) of 6 patients suffering from causalgic pain we will present our method of augmentative therapy in chronic neuropathic pain caused by peripheral nerve lesions, i. e., peripheral nerve stimulation (PNS), spinal cord stimulation (SCS) and chronic intrathecal opioid infusion. None of the patients showed intraoperative or follow-up complications. Evaluated by visual analogue scales all patients reported a good to excellent pain relief (75 - 100 %). (1) Regarding the favourable long-term results of PNS, this method should be considered in cases of mono-neuropathic pain syndromes. (2) Neuropathic pain syndromes which are not assignable to a singular nerve lesion, can often be managed effectively by SCS. (3) In contrast to the widespread opinion, deafferentation pain syndromes of central or peripheral origin can be treated satisfactorly by intrathecal opiate administration.

References

  • 1 Auld A W, Maki-Jokela A, Murdoch D M. Intraspinal narcotic analgesia in the treatment of chronic pain.  Spine. 1985;  19 778-781
  • 2 Atweh S F, Kuhar M J. Autoradiographic localization of opiate receptors in rat brain. II. The brain system.  Brain Res. 1977b;  129 1-9
  • 3 Blanchard J, Menk E, Ramamurthy S, Hoffman J. Subarachnoid and epidural calcitonin in patients with pain due to metastatic cancer.  J Pain Symptom Manag. 1990;  5 42-45
  • 4 Blumberg H, Jänig W. Changes in unmyelinated fibers including sympathetic post-ganglionic fibers of a skin nerve after peripheral neuroma formation.  J autonom nerv Syst. 1982;  6 173-183
  • 5 Blumberg H, Jänig W. Discharge pattern of afferent fibers from a neuroma.  Pain. 1984;  20 335-353
  • 6 Campbell J N, Davis K D, Meyer R A, North R B. The mechanisms by which dorsal column stimulation affects pain: evidence for a new hypothesis.  Pain. 1990;  5 228-232
  • 7 Chung J M, Fang Z R, Hori Y, Lee K H, Willis W D. Prolonged inhibition of primate spinothalamic tract cells by peripheral nerve stimulation.  Pain. 1984;  19 259-275
  • 8 Coombs D W, Saunders R L, Lachance D, Savage S, Ragnarsson T S, Jensen L E. Intrathecal morphine tolerance: use of intrathecal clonidine, DADLE, and intraventricular morphine.  Anesthesiology. 1986;  62 358-363
  • 9 Coombs D W, Saunders R L, Fratkin J D, Jensen L E, Murphy C A. Continuous intrathecal hydromorphone and clonidine for intractable cancer pain.  J Neurosurg. 1986;  64 890-894
  • 10 Dennis G C, DeWitty R L. Long-term intraventricular infusion of morphine for intractable pain in cancer of the head and neck.  Neurosurgery. 1990;  26 404-407
  • 11 Dougherty P M, Willis W D. Enhancement of STT neurons responses to chemical and mechanical stimulation following combined microiontophoretic application of NMDA and substance P.  Pain. 1991;  47 85-93
  • 12 Fields H L. Multiple opiate receptor sites on primary afferent fibers.  Nature. 1980;  184 351-356
  • 13 Gybels J M, Kupers R. Central and peripheral electrical stimulation of the nervous system in the treatment of chronic pain.  Acta Neurochir (Wien). 1987;  [Suppl.] 38 64-75
  • 14 Gybels J M, Sweet W H. Neurosurgical treatment of persistent pain: physiological and pathological mechanisms of human pain. Basel; Karger 1989
  • 15 Hassenbusch S J, Stanton-Hicks M, Schoppa D, Walsh J G, Covington E C. Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy.  J Neurosurg. 1996;  84 415-423
  • 16 Hassenbusch S J, Stanton-Hicks M D, Soukup J, Covington E C, Boland M B. Sufentanil citrate and morphine/bupivacaine as alternative agents in chronic epidural infusions for intractable non-cancer pain.  Neurosurgery. 1991;  29 76-81
  • 17 Ignelzi R J, Nyquist J. Direct effect of electrical stimulation in post-amputation pain.  Surg Neurol. 1976;  4 167-171
  • 18 Jorum E. The analgesic effects of peripheral nerve stimulation in various tests of nociception in rats.  Acta Physiol Scand. 1988;  133 131-138
  • 19 Kumar K, Nath R, Wyant G M. Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience.  J Neurosurg. 1991;  75 402-407
  • 20 Law J D, Swett J, Kirsch W M. Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation.  J Neurosurg. 1980;  52 482-485
  • 21 Lazorthes Y, Verdie J C, Caute B, Maranhao R, Tafani M. Intracerebroventricular morphinotherapy for control of chronic cancer pain. In: Fields HL, Besson JM (eds) Pain modulation progress in brain research. Amsterdam, New York, Oxford; Elsevier 1988: 395-405
  • 22 Leavens M E, Hill Jr C, Cech D A, Weyland J B, Weston J S. Intrathecal and intraventricular morphine for pain in cancer patients: Initial studies.  J Neurosurg. 1982;  56 241-245
  • 23 Levitt M. The theory of chronic deafferentation dysesthesias.  J Neurosurg Sci. 1990;  34 71-98
  • 24 Linderoth B, Gazelius B, Franck J, Brodin E. Dorsal column stimulation induces release of serotonin and substance P in the cat dorsal horn.  Neurosurgery. 1992;  31 289-297
  • 25 Long D M, Erickson D, Campbell J, North R. Electrical stimulation of the spinal cord and peripheral nerves for pain control.  Appl Neurophysiol. 1981;  44 207-217
  • 26 Melzack R, Wall P D. Pain mechanisms: a new theory.  Science. 1965;  150 971-978
  • 27 Meyerson B A. Spinal Cord Stimulation. In: Bonica, JJ (ed) The management of pain. Philadelphia; Lea and Febiger 1990: 1862-1868
  • 28 Nashold B S, Goldner J L. Electrical stimulation of peripheral nerves for relief of intractable chronic pain.  Med Instrum. 1975;  9 224-225
  • 29 Nashold Jr B S, Goldner J L, Mullen J B, Bright D S. Long-term pain control by direct peripheral nerve stimulation.  J Bone Joint Surg Am. 1982;  64 1-10
  • 30 North R B, Kidd D H, Zahuak M. Spinal cord stimulation for intractable chronic pain: experience over two decades.  Neurosurgery. 1993;  32 384-395
  • 31 Penn R D, Paice J A. Chronic intrathecal morphine for intractable pain.  J Neurosurg. 1987;  67 182-186
  • 32 Penn R D, Paice J A, Kroin J S. Octreotride: a potent new non-opiate analgesic for intrathecal infusion.  Pain. 1992;  49 13-19
  • 33 Pollard C A. Preliminary validity study of the Pain Disability Index.  Percept Mot Skills. 1984;  59 974-977
  • 34 Sato J, Perl E R. Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury.  Science. 1991;  251 1608-1610
  • 35 Shealy C N, Mortimer J T, Reswick J. Electrical inhibition of pain by stimulation of the dorsal column: preliminary clinical reports.  Anesth Analg. 1967;  46 489-491
  • 36 Simone D A, Sorkin L S, OH U, Chung J M, Owens C, LaMotte R H, Willis W D. Neurogenic hyperalgesia: Central correlates in response of spinothalamic tract neurons.  J Neurophysiol. 1991;  66 228-246
  • 37 Tait R C, Chibnall J T, Margolis R B. Pain extent: relations with psychosocial state, pain severity, pain history, and disability.  Pain. 1990;  41 295-298
  • 38 Turner J A, Loeser J D, Bell K G. Spinal cord stimulation for chronic low back pain: a systematic literature synthesis.  Neurosurgery. 1995;  37 1088-1095
  • 39 Vaccarino A L, Melzack R. The role of the cingulum bundle in self-mutilation following peripheral neurectomy in the rat.  Exp Neurol. 1991;  111 131-134
  • 40 Wall P D, Sweet W H. Temporary abolition of pain in man.  Science. 1967;  155 108-109
  • 41 Yaksh T L. Spinal opiate and analgesia: characteristics and principles of action.  Pain. 1981;  11 293-297
  • 42 Yingling C D, Hosobuchi Y. Use of antidromic evoked potentials in placement of dorsal cord disc electrodes.  Appl Neurophysiol. 1986;  49 36-41

Corresponding Author

Dr. Heinrich Ebel

Neurochirurgische Klinik Universität zu Köln

Joseph-Smann-Straße 9

50924 Köln

Germany

Telefon: + 49-2 21-4 78-45 57

Fax: + 49-2 21-4 78-59 21

    >