Neuropathic pain after brachial plexus avulsion--central and peripheral mechanisms.
METHODS
The pain that commonly occurs after brachial plexus avulsion poses an additional burden on the quality of life of patients already impaired by motor, sensory and autonomic deficits. Evidence-based treatments for the pain associated with brachial plexus avulsion are scarce, thus frequently leaving the condition refractory to treatment with the standard methods used to manage neuropathic pain. Unfortunately, little is known about the pathophysiology of brachial plexus avulsion. Available evidence indicates that besides primary nerve root injury, central lesions related to the abrupt disconnection of nerve roots from the spinal cord may play an important role in the genesis of neuropathic pain in these patients and may explain in part its refractoriness to treatment.


CONCLUSIONS
The understanding of both central and peripheral mechanisms that contribute to the development of pain is of major importance in order to propose more effective treatments for brachial plexus avulsion-related pain. This review focuses on the current understanding about the occurrence of neuropathic pain in these patients and the role played by peripheral and central mechanisms that provides insights into its treatment. Pain after brachial plexus avulsion involves both peripheral and central components; thereby it is characterized as a mixed (central and peripheral) neuropathic pain syndrome.
Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil. manoeljacobsen@gmail.com.|Pain Center, Instituto do Câncer de São Paulo, São Paulo, Brazil. manoeljacobsen@gmail.com.|Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil. manoeljacobsen@gmail.com.
Manoel Jacobsen
MJ
Teixeira
Functional Electrostimulation Laboratory, Federal University of Bahia, São Paulo, Brazil. matheus_paz2009@hotmail.com.
Matheus Gomes da S
MG
da Paz
Functional Electrostimulation Laboratory, Federal University of Bahia, São Paulo, Brazil. maurotupy@hotmail.com.
Mauro Tupiniquim
MT
Bina
Functional Electrostimulation Laboratory, Federal University of Bahia, São Paulo, Brazil. rgalhardoni@yahoo.com.br.
Scheila Nogueira
SN
Santos
Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil. iriraicher@gmail.com.|Pain Center, Instituto do Câncer de São Paulo, São Paulo, Brazil. iriraicher@gmail.com.
Irina
I
Raicher
Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil. rgalhardoni@gmail.com.|Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil. rgalhardoni@gmail.com.
Ricardo
R
Galhardoni
Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil. toledo.diego@uol.com.
Diego Toledo
DT
Fernandes
Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil. lintyeng@uol.com.br.|Centro de Dor, Instituto de Ortopedia e Traumatologia, University of São Paulo, São Paulo, Brazil. lintyeng@uol.com.br.
Lin T
LT
Yeng
Functional Electrostimulation Laboratory, Federal University of Bahia, São Paulo, Brazil. abrahao.baptista@gmail.com.
Abrahão F
AF
Baptista
Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil. ciampi@usp.br.|Pain Center, Instituto do Câncer de São Paulo, São Paulo, Brazil. ciampi@usp.br.|Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil. ciampi@usp.br.|Divisão de Clínica Neurocirúrgica do Hospital das Clínicas da FMUSP, Secretaria da Neurologia, Instituto Central, Av. Dr. Enéas de Carvalho Aguiar, 255, 5° andar, sala 5084 - Cerqueira César, 05403-900, São Paulo, SP, Brazil. ciampi@usp.br.
Daniel Ciampi
DC
de Andrade
D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000150:complications / Q000209:etiology*; D006801:Humans; D009437:Neuralgia / Q000209:etiology*