Surgical treatment of chronic lower extremity neuropathic pain

The current authors retrospectively reviewed 147 lower extremity peripheral nerve procedures in 114 patients (average age, 42 years) with chronic lowe r extremity neuropathic pain to determine whether surgical treatment based on an empirically derived algorithm could reduce pain and improve function. This algorithm assigns crush, stretch, and chronic transection injuries to treatment with transection and containment. Peripheral nerve stimulation w as used in conjunction with transection and containment for patients with m ore chronic presentations for whom previous transections had been unsuccess ful. Patients with adhesive neuralgia underwent revision neurolysis with ve in wrapping. Patients with repetitive nerve trauma (overuse) underwent prim ary or revision neurolysis. Duration of symptoms averaged 37 months, and me chanisms of nerve injury included chronic transection, crush, adhesive neur algia, stretch, repetitive trauma, and idiopathic etiology. Time to followu p averaged 38 months. Pain and dysfunction were ranked from 0 points (no pa in or dysfunction) to 10 points (pain prompting request for amputation or f unctional deficit warranting wheelchair use); preoperative and followup wor k status were documented. Average pain and dysfunction scores improved: 8.8 to 5.6 points and 7.6 to 5.0 points, respectively. Of the 114 patients, 52 (46%) patients improved their work status, including 35 of 87 (40%) involv ed in workers' compensation. There were no statistically significant differ ences in outcome based on mechanism of nerve injury or type of procedure. T he consistent average improvement suggests this algorithm assigns the appro priate procedure to a given mechanism of injury.