From the Research
Neuropraxia and axonotmesis are two distinct types of peripheral nerve injuries with different characteristics and recovery outcomes, and the most recent evidence suggests that axonotmesis has a slower and less predictable recovery compared to neuropraxia. Neuropraxia is the mildest form of nerve injury, involving temporary conduction block without physical disruption of the nerve, and typically results from compression or mild stretching of a nerve, causing local demyelination while preserving the axon itself 1. In contrast, axonotmesis involves actual disruption of the axon while preserving the surrounding connective tissue structures, and this more severe injury results from crushing or severe stretching forces and leads to Wallerian degeneration distal to the injury site.
The prognosis for axonotmesis is generally good but less predictable than neuropraxia, with the possibility of incomplete recovery or misdirected reinnervation. A study published in 2022 found that gabapentin and pregabalin have the most significant effect on relieving central poststroke pain, but also have the most adverse reactions 2. Another study published in 2015 found that duloxetine was associated with decreased outpatient visits, prescriptions, hospitalizations, and ED visits compared to pregabalin in patients with fibromyalgia 3.
Key Differences Between Neuropraxia and Axonotmesis
- Neuropraxia: temporary conduction block, no physical disruption of the nerve, recovery usually complete within weeks to months
- Axonotmesis: actual disruption of the axon, slower and less predictable recovery, possibility of incomplete recovery or misdirected reinnervation
- Recovery from axonotmesis occurs at a rate of approximately 1-3 mm per day as axons regenerate from the injury site, and may take months to years depending on the distance to the target tissue.
Treatment Options
- Gabapentin and pregabalin have been shown to be effective in relieving neuropathic pain, but may have adverse reactions 2
- Duloxetine may be associated with decreased health care utilization compared to pregabalin in patients with fibromyalgia 3
- The choice of treatment should be based on the individual patient's needs and medical history, and should prioritize minimizing morbidity, mortality, and improving quality of life.