Dorsal root entry zone lesioning for pain after brachial plexus avulsion: Results with special emphasis on differential effects on the paroxysmal versus the continuous components. A prospective study in a 29-patient consecutive series
Dorsal root entry zone lesioning for pain after brachial plexus avulsion: Results with special emphasis on differential effects on the paroxysmal versus the continuous components. A prospective study in a 29-patient consecutive series
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DOI：
10.1016/j.pain.2011.03.037
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发表时间：
2011-08-01
期刊：
影响因子：
7.4
通讯作者：
Sindou, Marc
中科院分区：
文献类型：
--
作者：
Aichaoui, Faycal;Mertens, Patrick;Sindou, Marc
臂丛神经撕脱 (BPA) 后的疼痛通常有两种主要不同成分：阵发性（电击样）疼痛和持续性（烧灼感）疼痛。背根进入区 (DREZ) 病变，即我们实践中使用的显微外科 DREZotomy (MDT)，已被证明是针对该适应症的一种有价值的神经外科治疗方法。然而，根据之前的研究，该方法对于以持续性疼痛为主的患者似乎没有像阵发性疼痛为主的患者那样有效。为了更深入地了解这个问题，我们对 MDT 程序对这两种成分的最终差异效应进行了前瞻性研究。所呈现的系列包括 29 名连续 29 名在过去 10 年接受过手术的 BPA 后疼痛的患者。使用视觉模拟量表（VAS）评估疼痛强度。在 MDT 后随访 12 至 122 个月（平均 60 个月）的 26 名患者的最后一次评估中，76.9% 的患者术后整体疼痛缓解良好或极好，即分别使用或不使用额外的非阿片类药物控制疼痛。根据疼痛的构成类型，84.6%的患者对阵发性疼痛的控制良好或优秀，73.1%的患者对持续性疼痛的控制良好或极好。 Kaplan-Meier 预测 120 个月的随访中持久的整体疼痛控制率为 41.1%。长期比较 2 条相应的 Kaplan-Meier 曲线，即阵发性疼痛控制率为 76.2%，连续性疼痛控制率为 43.1%，显示出统计学显着差异 (P = .038)。讨论了这种相对差异效应的假设。 (C) 2011 年国际疼痛研究协会。由 Elsevier B.V. 出版。保留所有权利。
Pain after brachial plexus avulsion (BPA) is generally characterized by 2 main different components: paroxysmal (electrical shooting-like) pain, and continuous (burning) pain. Dorsal root entry zone (DREZ) lesioning, namely, the microsurgical DREZotomy (MDT) used in our practice, has proved to be a worthwhile neurosurgical treatment for this indication. However, according to previous studies, the method does not seem to demonstrate as good effectiveness in patients in whom the continuous background of pain was predominant as in patients with the paroxysmal component predominating. To obtain more insight into this problem, a prospective study on an eventual differential effect of the MDT procedure on the 2 components was undertaken. The presented series included 29 consecutive patients affected with pain after BPA who underwent an operation over the 10 last years. Pain intensity was evaluated using a visual analogue scale (VAS). At last evaluation of the 26 patients followed for 12 to 122 months (60 months on average) after MDT, 76.9% had a good or excellent global pain relief after surgery, ie, pain control with or without additional nonopioid medications, respectively. According to the component types of pain, 84.6% of patients had good or excellent control of the paroxysmal pain, and 73.1% of the continuous pain. Kaplan-Meier prediction of lasting global pain control at 120 months of follow-up was calculated at 41.1%. Comparison of the 2 corresponding Kaplan-Meier curves at long term, namely, pain control in 76.2% for the paroxysmal component and in 43.1% for the continuous component, showed a statistically significant difference (P = .038). Hypotheses for this relative differential effect are discussed. (C) 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.