Treating Nerve Pain With the 3 Rs: Release, Repair, or Removal.

The three ‘Rs’ of peripheral nerve surgery: Release, repair, removal.

A successful nerve surgery typically provides significant but not total relief. We consider more than 50% improvement to be successful. Depending on the type of nerve damage, we’ll perform one of three surgeries:

• Releasing a compressed (or “pinched”) nerve: If your nerve pain starts a few weeks or months after a surgery, it’s likely because a nerve is being compressed by scar tissue that built up as your body healed. During a procedure called neurolysis, we release the nerve from this pressure by removing the excess scar tissue. You will need to perform specific movements and stretches on a regular basis to improve the nerve’s range of motion and prevent further scarring.
• Repairing a damaged nerve: If your pain starts almost immediately after an operation, a nerve might have been severed or damaged. Our first step is to repair the nerve by sewing the severed ends back together. If the ends are too frayed to be reconnected, we may be able to perform a nerve transfer. That means we connect the damaged nerve to a nearby functioning one. You can think of a cut nerve as a frayed cord with exposed live wire that must be reconnected to restore the “circuit” between the nerve and brain. Once a nerve is repaired and functioning more normally, its fibers will grow back within six months to a year.
• Removing a damaged nerve: If your nerve is too damaged to be repaired, we can remove it to prevent the nerve from sending pain signals to your brain. However, because peripheral nerves can grow back, the pain likely will return in less than a year. To reduce the severity of the pain, we will recommend ongoing therapies such as medications or exercises to help increase blood flow, strengthening the nerve tissue. Evidence consistently shows that physical activity can alleviate peripheral nerve pain.

For each type of surgery, we use an operating microscope that can magnify the affected area up to 40 times, which helps us accurately perform such an intricate procedure using specialized microsurgical instruments. Many patients notice a dramatic improvement shortly after surgery, though the incision area may be sore for a few weeks.

Seek nerve care early to improve long-term pain relief. 

Research to better understand peripheral nerve pain is ongoing, and surgical techniques are continually studied and improved to decrease complications such as nerve damage. Nerve pain caused by an injury or operation is not preventable, but it is progressive; the longer you wait, the less effective treatment will be. See your doctor right away if you experience symptoms of nerve damage.

If we can’t attribute the pain to a nerve, we’ll order more imaging for a closer look at the affected area or refer you to a specialist, such as an orthopedic surgeon, to evaluate for structural causes of pain such as bone and joint issues. Unfortunately, chronic nerve pain rarely goes away completely. However, a combination of multidisciplinary treatments, such as physical therapy, regular exercise, medication, and pain management treatment can hopefully provide significant relief.

I see patients at MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Our team understands the many ways chronic nerve pain impacts quality of life and will work with you and our MedStar Health pain management experts to develop a creative, customized treatment plan that can help you more easily resume your favorite activities.