From the Guidelines
Peripheral neurectomy is not recommended as a primary treatment for chronic pain conditions, including causalgia, due to its limited long-term effectiveness and potential risks. The evidence indicates that benefits from peripheral neurectomy typically last only a short period, with pain recurring in most patients within 24-32 months 1. This is because severed nerves often regenerate or form painful neuromas at the transection site, leading to the recurrence of pain. Additionally, the procedure carries risks including sensory loss, dysesthesia, and infection. Some key points to consider when evaluating the effectiveness of peripheral neurectomy include:
- The development of ectopic neural activity at injury sites, along with maladaptive neuroplastic changes in the central nervous system, which can lead to persistent pain circuits that function independently of peripheral input 1.
- The potential for peripheral neurectomy to worsen pain in the long term, rather than providing lasting relief 1.
- The availability of alternative treatments, such as medication, physical therapy, and neuromodulation, which may be more effective in managing chronic pain conditions 1. Overall, the current evidence suggests that peripheral neurectomy is not a recommended treatment for chronic pain conditions, and that other approaches should be considered first.
From the Research
Effectiveness of Peripheral Neurectomy in Treating Pain
- Peripheral neurectomy has been shown to be effective in treating neuropathic pain, particularly in conditions like causalgia, where cut nerves lead to prolonged pain 2, 3, 4.
- The procedure involves the transection of affected sensory nerves, which can provide significant pain relief, with some studies reporting complete resolution of pain in a subset of patients 3, 4.
- Customized nerve reconstruction can be used in conjunction with peripheral neurectomy to improve outcomes and reduce the risk of complications 4.
Conditions Treated with Peripheral Neurectomy
- Trigeminal neuralgia: Peripheral neurectomy has been shown to be a safe and effective procedure for treating trigeminal neuralgia, particularly in elderly patients or those living in rural areas with limited access to neurosurgical facilities 3.
- Periorbital neuropathic pain: Peripheral neurectomy with customized nerve reconstruction has been used to treat severe, intractable periorbital neuropathic pain, with significant improvements in pain scores reported 4.
- Causalgia: While not specifically mentioned in the provided studies, peripheral neurectomy may be considered as a treatment option for causalgia, given its effectiveness in treating other types of neuropathic pain 2, 5.
Mechanisms and Considerations
- Pain masking and unmasking: The phenomenon of pain masking and unmasking can occur after neurectomy, where the treatment of one pain generator reveals a previously unrecognized pain source 6.
- Diffuse noxious inhibitory control: This concept describes the pain-inhibits-pain pathway, which may help explain the phenomenon of masking and unmasking 6.
- Nerve regeneration: The use of techniques such as obturating the foramen with stainless steel screws can prevent nerve regeneration and prolong remission of pain 3.