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

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Approximately 10% of the general population may experience chronic pain caused by nerve damage. Most of the patients referred to our plastic surgery clinic for nerve pain are seeking relief from peripheral nerve damage, which can affect any nerves outside the central nervous system (the brain and spinal column). 


Nearly 90% of patients with peripheral nerve damage can experience the following symptoms in their limbs, hands, or feet:

  • Tingling
  • Numbness
  • Burning pain
  • Hypersensitivity
  • Weakness

Peripheral nerve damage can be caused by a range of factors outside a patient’s control—including treatments for other health conditions. Many patients struggle with nerve pain after recovering from:

  • Injury: This can include fractures or sprains. Often, we treat brachial plexus injuries, in which an arm is severely stretched or pulled in a vehicle accident, contact collision, or knife or gunshot wound.
  • Disease: Infections, nutritional imbalances, diabetes, and medications such as chemotherapy can temporarily or permanently damage nerves. 
  • Surgery: A nerve may be damaged or irritated during major—yet fine—surgeries such as a hand or foot fracture repair, joint replacement, or mastectomy.

Some patients try medication or physical therapy with limited improvement before visiting me for other options. Many are worried they’ll have to have surgery to relieve the pain. Surgery should be a last resort—but when no better options exist, improvement can be significant. 

 

Most patients benefit from less invasive therapies that can significantly reduce peripheral pain and improve quality of life. However, nerve surgery may be the best option if we can narrow down the source of pain to one specific nerve or small set of nerves.

 

‘Try it before you buy it’: How nerve blocks help determine treatment options.

A damaged nerve is only one potential reason a patient might have chronic pain or other nerve symptoms. If the pain is in just one or two fingers, for example, or one part of your foot, it’s likely due to one damaged nerve. If it’s spread across a larger area, it could be due to several nerves or other tissues.

 

The best diagnostic tool for peripheral nerve pain is a temporary, ultrasound-guided nerve block, which numbs the nerve we think is causing the pain. Using ultrasound imaging, we inject local anesthetic around a specific nerve that we believe may be the cause of a patient’s pain, which should numb any pain the damaged nerve is causing for four to six hours. 


The pain relief you experience from a nerve block is similar to what you would experience after a nerve surgery. If you still feel the same amount of pain, that nerve is not the cause of the pain, and nerve surgery will not relieve your pain. However, if you feel temporary pain relief after the injection, we can attribute the pain to that nerve, and surgery might be an option.

 

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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.

 

 

Are you experiencing peripheral nerve pain?

Our pain management specialists can help.

Call 202-877-DOCS (3627) or Request an Appointment

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