title: Usefulness of screening tools in the evaluation of long-term effectiveness of DREZ lesioning in the treatment of neuropathic pain after brachial plexus injury.
abstract: BACKGROUND
  Despite high success rate of DREZ lesioning in the treatment of intractable central pain, there is still a significant incidence of patients without satisfactory post-operative effect. The aim of the study was to evaluate the long-term effect of DREZ lesioning using both a subjective assessment using a visual analog scale (VAS) to quantify residual pain and an assessment using the screening tool (painDETECT Questionnaire, PD-Q).
  
  
  METHODS
  DREZ lesioning was performed in 52 patients from a total 441 cases with brachial plexus injury (11.8%) during a 17-year period (1995-2011). The effect of surgery was retrospectively assessed in 48 patients.
  
  
  RESULTS
  A decrease in pre-operative pain by more than 75% (Group I) was achieved in 70.8% of patients and another 20.8% reported significant improvement (Group II). The surgery was unsucessful in 8.4% (Group III). We found a significant correlation between 'improvement' groups from both methods of assessments. Patients from Group I usually complained of residual nociceptive pain according to PD-Q, patients from Group II typically had pain of unclear origin, and all cases those in Group III suffered from neuropathic pain, Cramer's V = .66, P < .001. Overall, 66.7% of patients had resolved neuropathic pain, 20.8% patients had more serious complaints and may also suffer from residual neuropathic pain, while 12.5% had unresolved neuropathic pain.
  
  
  CONCLUSIONS
  DREZ lesioning is a safe and effective method with success rates of about 90%. PD-Q scores correspond to subjective satisfaction with the surgery and it seems to be a suitable screening tool for finding patients with residual neuropathic pain after surgery.
authors.affiliation: Department of Neurosurgery, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Srobarova 50 100 34, Prague, Czech Republic. pavel.haninec@fnkv.cz.
authors.forename: Pavel
authors.initials: P
authors.lastname: Haninec
authors.affiliation: Department of Neurosurgery, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Srobarova 50 100 34, Prague, Czech Republic. rkaiser@hotmail.cz.
authors.forename: Radek
authors.initials: R
authors.lastname: Kaiser
authors.affiliation: Department of Neurosurgery, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Srobarova 50 100 34, Prague, Czech Republic. mencl.libor@gmail.com.
authors.forename: Libor
authors.initials: L
authors.lastname: Mencl
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Prague, Czech Republic. petrwaldauf@seznam.cz.
authors.forename: Petr
authors.initials: P
authors.lastname: Waldauf
mesh_terms: D000328:Adult; D000368:Aged; D001917:Brachial Plexus / Q000293:injuries*; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D010147:Pain Measurement / Q000379:methods* / Q000592:standards; D010148:Intractable Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000601:surgery*; D011795:Surveys and Questionnaires; D055815:Young Adult