Retrospective Analysis and Long-Term Follow-Up of Neuropathic Pain in Patients Operated for Traumatic Brachial Plexus Injury: Neurogenic Pain in Patients Operated for Traumatic Brachial Plexus Injury

Introduction: Long-term evaluation in patients operated for traumatic brachial plexus injury was done to study the various types of neuropathic pain and their severity, assess them with factors like the age/sex of the patients, severity of injury, type of injury (partial/complete), occupation, education, operative procedures, quality of life and mental state of the patients

Methods: The analysis was retrospective, and 850 patients were included in the study. The neuropathic pain was identified with the DN4 questionnaire, and the Neuropathic Pain Symptom Inventory was used to evaluate different symptoms of neuropathic pain. The SF36 questionnaire and the Beck Depression Inventory (BDI) were used to assess the quality of life and mood disturbances. The follow-up ranged from 3 years to 15 years. The neuropathic pain was also evaluated with the type of brachial plexus injury (partial/complete), operative procedures like neurolysis, nerve grafting and nerve transfer. Neuropathic pain was studied for the quality of life and mental status of patients. The response of medications, and physical therapy was also studied.

Results: Neuropathic pain was found in 808 patients, and spontaneous burning pain was the most common type. It was severe in complete brachial plexus injury compared to partial upper roots injury. In the complete type of injury with roots avulsion, the neuropathic injury was severe, long-lasting and refractory to medical management in 24% of patients. In partial injury without root avulsion, neuropathic pain was noted only in 2% of patients. The electrophysiological findings were affected in patients with severe neuropathic pain. In complete injury, 18% of patients had worsening neuropathic pain following nerve transfer procedures. The quality of life was significantly affected in 15% of patients with the complete type of injury with severe neuropathic pain, and 9% of patients had depression of varying severity.

Conclusion : The severity of neuropathic pain is related to the severity of injury like avulsion injury. A significant number of patients with complete brachial plexus injury continue to suffer from neuropathic pain, affecting their quality of life and mental status.