Evaluation of Pain Measurement Practices and Opinions of Peripheral Nerve Surgeons

Overview

Journal Hand (N Y)

Publisher Sage Publications

Specialties General Surgery
Orthopedics

Date 2009 Feb 26

PMID 19241111

Citations 4

Authors

Christine B Novak

Dimitri J Anastakis

Dorcas E Beaton

Joel Katz

Affiliations

Soon will be listed here.

Abstract

The purpose of this study was to evaluate the opinions and practices of peripheral nerve surgeons regarding assessment and treatment of pain in patients following nerve injury. Surgeons with expertise in upper extremity peripheral nerve injuries and members of an international peripheral nerve society were sent an introductory letter and electronic survey by email (n = 133). Seventy members responded to the survey (49%) and 59 surgeons completed the survey (44%). For patients referred for motor or sensory dysfunction, 31 surgeons (52%) indicated that they always formally assess pain. In patients referred for pain, 44 surgeons (75%) quantitatively assess pain using a verbal scale (n = 24) or verbal numeric scale (n = 36). The most frequent factors considered very important in the development of chronic neuropathic pain were psychosocial factors (64%), mechanism of injury (59%), workers' compensation or litigation (54%), and iatrogenic injury (48%). In patients more than 6 months following injury, surgeons frequently see: cold sensitivity (54%), decreased motor function (42%), paraesthesia or numbness (41%), fear of returning to work (22%), neuropathic pain (20%), and emotional or psychological distress (17%). Only 52% of surgeons who responded to the survey always evaluate pain in patients referred for motor or sensory dysfunction. Pain assessment most frequently includes verbal patient response, and assessment of psychosocial factors is rarely included. Predominately, patient-related factors were considered important in the development of chronic neuropathic pain.

Citing Articles

Concepts of Pain Management Following Nerve Injuries: Multidisciplinary Approach.

Faust A, DeMartini S, Carey-Ewend A, Crock L, Buday S, Brogan D J Hand Surg Glob Online. 2024; 6(5):749-755.

PMID: 39381396 PMC: 11456641. DOI: 10.1016/j.jhsg.2024.01.019.

Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus.

Hill J, Lanier S, Rolf L, James A, Brogan D, Dy C Hand (N Y). 2021; 18(1_suppl):14S-21S.

PMID: 34018448 PMC: 9896279. DOI: 10.1177/15589447211014613.

Frequency and Risk Factors for Prolonged Opioid Prescriptions After Surgery for Brachial Plexus Injury.

Dy C, Peacock K, Olsen M, Ray W, Brogan D J Hand Surg Am. 2019; 44(8):662-668.e1.

PMID: 31078338 PMC: 7193763. DOI: 10.1016/j.jhsa.2019.04.001.

Neuropathic pain in patients with upper-extremity nerve injury.

Novak C, Katz J Physiother Can. 2011; 62(3):190-201.

PMID: 21629596 PMC: 2909869. DOI: 10.3138/physio.62.3.190.

References

Jaquet J, Luijsterburg A, Kalmijn S, Kuypers P, Hofman A, Hovius S . Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity. J Trauma. 2001; 51(4):687-92. DOI: 10.1097/00005373-200110000-00011. View

Chuang D, Lee G, Hashem F, Wei F . Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg. 1995; 96(1):122-8. DOI: 10.1097/00006534-199507000-00019. View

Samii M, Ludemann W, Tatagiba M, Blomer U . Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions. Neurosurgery. 2001; 48(6):1269-75; discussion 1275-7. View

Chuang D, Epstein M, Yeh M, Wei F . Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injury). J Hand Surg Am. 1993; 18(2):285-91. DOI: 10.1016/0363-5023(93)90363-8. View

VanGeest J, Johnson T, Welch V . Methodologies for improving response rates in surveys of physicians: a systematic review. Eval Health Prof. 2007; 30(4):303-21. DOI: 10.1177/0163278707307899. View

Collins E, Novak C, Mackinnon S, Weisenborn S . Long-term follow-up evaluation of cold sensitivity following nerve injury. J Hand Surg Am. 1996; 21(6):1078-85. DOI: 10.1016/S0363-5023(96)80319-4. View

Bertelli J, Ghizoni M . Pain after avulsion injuries and complete palsy of the brachial plexus: the possible role of nonavulsed roots in pain generation. Neurosurgery. 2008; 62(5):1104-13. DOI: 10.1227/01.neu.0000325872.37258.12. View

Chuang D, Yeh M, Wei F . Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients. J Hand Surg Am. 1992; 17(5):822-8. DOI: 10.1016/0363-5023(92)90451-t. View

Akl E, Maroun N, Klocke R, Montori V, Schunemann H . Electronic mail was not better than postal mail for surveying residents and faculty. J Clin Epidemiol. 2005; 58(4):425-9. DOI: 10.1016/j.jclinepi.2004.10.006. View

10.

Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P . Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am. 2003; 28(4):633-8. DOI: 10.1016/s0363-5023(03)00199-0. View

11.

Ahmed-Labib M, Golan J, Jacques L . Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery. 2007; 61(5):1016-22. DOI: 10.1227/01.neu.0000303197.87672.31. View

12.

Htut M, Misra P, Anand P, Birch R, Carlstedt T . Pain phenomena and sensory recovery following brachial plexus avulsion injury and surgical repairs. J Hand Surg Br. 2006; 31(6):596-605. DOI: 10.1016/j.jhsb.2006.04.027. View

13.

Irwin M, Gilbert S, Terenghi G, Smith R, Green C . Cold intolerance following peripheral nerve injury. Natural history and factors predicting severity of symptoms. J Hand Surg Br. 1997; 22(3):308-16. DOI: 10.1016/s0266-7681(97)80392-0. View

14.

Graham B, Schofield M . Self-reported symptoms of cold intolerance in workers with injuries of the hand. Hand (N Y). 2008; 3(3):203-9. PMC: 2525881. DOI: 10.1007/s11552-008-9116-0. View

15.

Carlsson I, Cederlund R, Holmberg J, Lundborg G . Behavioural treatment of post-traumatic and vibration-induced digital cold sensitivity. Scand J Plast Reconstr Surg Hand Surg. 2004; 37(6):371-8. DOI: 10.1080/02844310310013055. View

16.

Aberg M, Ljungberg C, Edin E, Jenmalm P, Millqvist H, Nordh E . Considerations in evaluating new treatment alternatives following peripheral nerve injuries: a prospective clinical study of methods used to investigate sensory, motor and functional recovery. J Plast Reconstr Aesthet Surg. 2007; 60(2):103-13. DOI: 10.1016/j.bjps.2006.04.019. View

17.

Cruccu G, Anand P, Attal N, Garcia-Larrea L, Haanpaa M, Jorum E . EFNS guidelines on neuropathic pain assessment. Eur J Neurol. 2004; 11(3):153-62. DOI: 10.1111/j.1468-1331.2004.00791.x. View

18.

Gilron I, Watson C, Cahill C, Moulin D . Neuropathic pain: a practical guide for the clinician. CMAJ. 2006; 175(3):265-75. PMC: 1513412. DOI: 10.1503/cmaj.060146. View

19.

Bruxelle J, Travers V, Thiebaut J . Occurrence and treatment of pain after brachial plexus injury. Clin Orthop Relat Res. 1988; (237):87-95. View

20.

Cull W, OConnor K, Sharp S, Tang S . Response rates and response bias for 50 surveys of pediatricians. Health Serv Res. 2005; 40(1):213-26. PMC: 1361134. DOI: 10.1111/j.1475-6773.2005.00350.x. View