Neuropathic pain after C7 spinal nerve transection in man.
Various animal models of neuropathic pain have been developed which involve creating a lesion in a spinal root. We describe a human correlate in which patients developed a neuropathic pain syndrome after having one spinal nerve surgically divided. In some patients with brachial plexus lesions, the C7 spinal nerve from the opposite side is divided and used as a nerve transfer to re-innervate the injured brachial plexus. Of five patients that underwent this procedure, one went on to develop a transient but significant neuropathic pain problem. Extensive sensory testing in this patient 2 months after surgery revealed dysesthesia and hyperalgesia to mechanical and cooling stimuli, but not to heat stimuli in the C7 dermatome of the hand on the side of C7 section. The pain and hyperalgesia persisted during a phentolamine infusion, which produced a sympathetic blockade. Only mild parasthesia persisted at a 1 year follow up. Thus, surgical division of a single spinal nerve in humans can lead to the development of neuropathic pain.
Ali
Zahid
Z
Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21218, USA.
Meyer
Richard A
RA
Belzberg
Allan J
AJ
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery*; D002648:Child; D003080:Cold Temperature; D005260:Female; D006358:Hot Temperature; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis / Q000209:etiology; D008297:Male; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology*; D017288:Pain Threshold; D010646:Phentolamine / Q000008:administration & dosage; D010812:Physical Stimulation; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D013127:Spinal Nerves / Q000601:surgery*; D013497:Sural Nerve / Q000637:transplantation; D013565:Sympatholytics / Q000008:administration & dosage
D000317:Adrenergic alpha-Antagonists; D013565:Sympatholytics; D010646:Phentolamine