Implications of the failure of nerve resection and graft to cure chronic pain produced by nerve lesions

Abstract

Seven patients had developed pain and abnormal sensitivity in the area supplied by a single nerve which had been injured. They were treated unsuccessfully for periods ranging from 3 to 108 months by conservative methods including neurolysis, local anaesthesia, sympathetic blocks, guanethidine, transcutaneous stimulation and analgesics. All then had the damaged nerve resected and in five cases a sural nerve graft was inserted to bridge the resected gap. The patients were then examined 20 to 72 months after the operation. In all seven cases pain and abnormal sensitivity of some intensity recurred in the same area and with the same qualitative characteristic as experienced before the operation. This operation should not be done in patients with this condition. Reasons are given to suggest that peripheral nerve damage induces changes in the central nervous system which are not reversed by treatment directed at the area of the original injury.