Neuropathic pain
Neuropathic pain may be associated with changes in colour and perfusion of the skin area in the involved extremity as a result of failure of physiological autoregulatory mechanisms and evolve into a chronic regional pain syndrome. Spontaneous pain as a consequence of brachial plexus injury has been mentioned previously.
Surgical exploration of the site of nerve injury may discern a remediable structural cause of pain.
Non-surgical management of neuropathic pain involves the use of drugs such as pregabalin, amitryptiline, and duloxetine and the help of psychologists and other therapists. We also offer Qutenza (a topical treatment derived from capsaicin) by GP/consultant referral. Our specialised pain management teams can bring to bear a variety of resources.
In rare cases when extensive treatment by pain specialists has not sufficed, neuromodulative treatment such as electrical stimulation of the spinal cord may be considered.
In this method, electrodes are brought into contact directly with the posterior spinal cord. Then a test stimulation is applied for a day or two that follows electrode placement, and the patient is asked about the level of pain.
If the test stimulation is effective, then a compact impulse generator is implanted in a subcutaneous pouch and connected to the previously placed electrode.
These generators are equipped with batteries that last 5-10 years, depending on the programming used for stimulation, after which time they require changing. Some modern generators are rechargeable using transcutaneous contact interfaces; however, they require quite frequent recharging.
