PAIN IN AVULSION LESIONS OF THE BRACHIAL-PLEXUS

  • 1 January 1985
    • journal article
    • research article
    • Vol. 31  (5) , 435-441
Abstract
Pain in avulsions lesions of the brachial plexus is related to deafferentation; experimental studies demonstrate that spontaneous discharges can be recorded with microelectrodes in the dorsal horn after division of the dorsal roots. These discharges (firing) are related to the loss of control of the inhibitory effects of the large caliber sensory fibers. This pathophysiological concept drawn from Melzack and Wall''s theory (gate control) allows interpretation of the paradoxical results observed after neurotization (via accessory or intercoastal nerves), namely immediate relief of pain, observed in several cases after surgery. This theory helps to explain the efficiency of the neurostimulation techniques (by inhibition of the firing) and of the technique of dorsal root entry zone coagulation in the avulsed area, on the spinal cord, by direct destruction of the hyperactive cells in the posterior horn. These technical advances and early return to work and to community offer the best prospect of relief of pain. Incidence of intractable pain problem is less than 10% after 10 years.