Floor plan - 2013 Annual Meeting - American Association for Hand ...

Practical Clinical Guide for the Management of Chronic Pain Secondary to Neuropathic
Conditions
Institution where the work was prepared: Hand and Microsurgery Center of El Paso and UTEP, El Paso, TX, USA
Jose Monsivais, MD; Hand & Microsurgery Center; Kris Robinson, PhD, FNP; University of Texas at El Paso
INTRODUCTION:
Chronic pain secondary to peripheral neuropathic conditions is frequently seen in clinical practice. However, precipitous surgical treatment
in the presence of undiagnosed psychosocial dysfunction will end up in frustration for both the surgeon and the patient.
MATERIALS/METHOD:
Psychosocial dysfunction was recognized through clinical acumen and the use of multidimensional assessment of pain (VAS, Wong-
Baker, and BPI). The clinical diagnosis of neuropathy was determined using standard sensory-motor evaluations and electrodiagnostic
and imaging studies (MRI). An archival review of records from 91 patients treated for neuropathic pain over a ten-year period in a specialty
clinic were included. Inclusion criteria were individuals with proven nerve dysfunction experiencing pain > 3 months. Surgical candidates
were determined by the severity of sensory-motor abnormalities and showed evidence of improved psychosocial functioning
as measured by the Brief Pain Inventory (BPI). Surgical procedures included nerve decompressions, reconstruction, neurolysis, and excision
of neuromas. Medical treatment included analgesics, adjuvants, and neuroleptic medications. Psychosocial treatment included a
prescription to remain or return to work on a predetermined date and daily exercise. Patient progress was monitored by pain diary, BMI,
pulse, and biological markers when applicable. Participants received periodic clinical evaluation of sensory and motor function, and
assessment of pain.
RESULTS:
Over 93% (85/91) of patients returned to work and reported lower levels of pain up to 5 years after onset of nerve injury/ condition. In
addition, no differences were noted between individuals treated medically or surgically on a variety of psychosocial measures after treatment
including pain level (p=.2), litigation status (p > .5), and return to work (p>.05). The majority of individuals expected total relief of
pain with surgical treatment. This issue needs to be addressed to insure that patients have a realistic expectation of the treatment,
whether surgical or medical.
CONCLUSION:
With psychosocial assessment, support, and adequate pain treatment, there seems to be no difference in functional outcomes on several
levels between those patients receiving surgical and non-surgical treatment. Patients' expectations of total pain relief with surgery
are unrealistic and must be addressed prior to treatment. In summary, early recognition and treatment of psychosocial dysfunction leads
to improved outcomes as measured by improvement in pain, neurological signs/symptoms, and functionality.
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