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Clinical Analysis of Treatment for Refractory Pain of the Upper Limb with Posterior Rhizotomy on Cervical Spinal Cord

Author: LiQiang
Tutor: CuiShuSen
School: Jilin University
Course: Clinical
Keywords: Refractory pain Operative therapy Posterior rhizotomy
CLC: R658
Type: Master's thesis
Year: 2009
Downloads: 39
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Abstract

Refractory pain of the upper limb is an intractable problem for the hand surgeon. The cause of pain includes avulsion of the brachial plexus, brachial plexus compression injury by cancer, radiation brachial plexus injury, post-amputation stump pain, phantom limb pain, etc. Patients with such kind of pain always have some or even all loss of upper extremity sensory and motor. However, once intractable pain appeared, patients need pain relief more than the recovery of sensory and motor. Some one even demands the amputation to alleviate the pain. Therefore refractory pain has become a serious problem and is in extensive research.With study of the pain pathway and mechanism, many treatments have been undertaken in an attempt to alleviate chronic pain. Drug analgesia, nerve block, electrical stimulation analgesia, peripheral or central nervous system damage surgery are all commonly used and easily accepted. Such treatments are primary procedures for the intractable pain, with varying degrees of long-term effect. However, a completely satisfactory way of analgesia is still not found. In recent years, many scholars advocate the use of multi-modal or balanced analgesia for the treatment of intractable pain, which integrates a number of the upcoming ways to achieve the purpose of pain relief.One way to treat the upper extremity chronic pain is the posterior rhizotomy on cervical spinal cord. However, with completely sensory lost as a result, this operation needs more stringent selection of cases. Since March 2008 to October, we have obtained good results in 2 patients with irritation of intractable pain in the upper extremity using the posterior rhizotomy on cervical spinal cord combined with a drug treatment.On the basis of clinical cases research, this article aims to explore the clinical effect and application value of the posterior rhizotomy on cervical spinal cord in the treatment of the upper limb refractory pain.A retrospective analysis of 2 cases with refractory pain treated by the posterior rhizotomy on cervical spinal cord was made to achieve the purposes. We compared the clinical manifestations of patients, pain visual analogue score (Visual analogue scale, VAS), sleep quality and pain relief drug application before and after the operation.The 2 patients achieved satisfactory results. At the first day after the operation, the pain of the original area and the tenderness point pain disappear, also other kinds of sensory. For both of them, the VAS score dropped 8 points; the daily sleep time increase from less than 2 hours to 6 hours or more; and the number of daily applications of morphine decrease from 12 ,10 tablets to less than 4 tablets. In more than 20 days before they discharged from hospital, the relief of pain is in stability.Both of them didn’t show significantly complications related to the operation. However, one patient was dead due to the proliferation of cancer 1 month after the operation. Another patient had no complains of tenderness point pain in the following 4 months, also the pain of the original area didn’t relapse and the VAS dropped to 0 point. Although there is still mild phantom limb pain and a small number of anti-epileptic drugs are used every day, the patient shows satisfactory because of the great improvement of the quality of sleep and life.Conclusion: To the patient with obvious nerve pain in the upper limb, the posterior rhizotomy on cervical spinal cord is effective in short term, but long-term effects need to be further followed-up. This operation is effective and of great value to patients with a refractory nerve pain (such as stump pain) in the upper limb, but its clinical indication should be strictly selected.

Clinical Analysis of Treatment for Refractory Pain of the Upper Limb with Posterior Rhizotomy on Cervical Spinal Cord

Abstract

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