Treatment of neuropathic deafferentation pain using DREZ lesions; long-term results

Información del artículo

Abstract

Introduction

Deafferentation pain secondary to spinal cord injury, brachial plexus avulsion and other peripheral nerve injuries is often refractory to conventional treatments. This study evaluates the long-term efficacy of spinal DREZ (Dorsal Root Entry Zone) lesions for the treatment of neuropathic pain syndromes caused by deafferentation.

Patients and methods

A series of 18 patients with refractory deafferentation pain treated with radiofrequency DREZ lesions is presented. The immediate and long-term efficacy was measured with the Visual Analogue Scale (VAS) before and after treatment, the patient's subjective evaluation, the percentage of patients returning to work and the reduction in pain medication.

Results

Pain on the VAS significantly decreased from 8.6 preoperatively to 2.9 (p<.001) at release. Over the long-term, with a mean follow-up of 28 months (6–108) pain remained at 4.7 on the VAS (p<0.002). The percentage of patients with moderate to excellent pain relief was 77% at discharge and 68% at the last follow-up. Pain medication was reduced in 67% of the patients and 28% returned to work. The best results were obtained in patients with brachial plexus avulsion, with a significant long-term pain relief in all cases.

Conclusions

Radiofrequency DREZ lesion is an effective and safe treatment for refractory neuropathic pain caused by deafferentation.

Keywords:

Brachial plexus avulsion

Deafferentation

Dorsal root entry zone

Pain

Spinal injury

Resumen

Introducción

El dolor por desaferentización secundario a lesiones medulares, avulsión del plexo braquial y otras lesiones de nervios periféricos, es a menudo refractario a tratamientos convencionales. Este trabajo evalúa la eficacia a largo plazo de la cirugía de lesión DREZ (Dorsal Root Entry Zone) en diversos síndromes de dolor neuropático por desaferentización.

Pacientes y métodos

Se presenta una serie de 18 pacientes con dolor refractario por desaferentización tratados mediante lesión DREZ con radiofrecuencia. La eficacia inmediata y a largo plazo se valoró mediante la escala visual analógica (EVA) preoperatoria y postoperatoria, la valoración subjetiva del paciente, la reincorporación laboral y la reducción de la medicación analgésica.

Resultados

El dolor en la EVA disminuyó significativamente de 8,6 antes de la cirugía a 2,9 de media al alta (p<0,001). A largo plazo, con un seguimiento medio de 28 meses (6–108), el dolor se mantuvo en 4,7 en la EVA (p<0,002). El porcentaje de pacientes con un alivio moderado a excelente del dolor fue de 77% al alta y 68% a largo plazo. El 67% de los pacientes redujo la medicación analgésica y el 28% se reincorporó al trabajo. Los mejores resultados se obtuvieron en los pacientes con avulsión del plexo braquial con una mejoría significativa del dolor a largo plazo en todos los casos.

Conclusiones

La lesión DREZ por radiofrecuencia es un tratamiento eficaz y seguro para el dolor neuropático refractario por desaferentización.

Palabras clave:

Avulsión plexo braquial

Desaferentización

Dorsal root entry zone

Dolor

Lesión medular

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†

Dr. Francisco García Salazar, the driving force behind pain surgery at our department and the lead surgeon in all the cases presented in this series, died on October 5th, 2009, during the preparation of this manuscript. R.I.P.

☆

No work similar to this manuscript has been published or submitted to another journal for publication. Some of the data included in this work were reported at the 14th Annual Conference of the Spanish Neurology Society (SENEC) held in Seville in May 2009.

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