American Society for Peripheral Nerve

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A Proximal Crush Nerve Injury Prevents Neuropathic Pain
Ian Wood, B.S.1; Jane Wang, BS2; Lauren Schellhardt, BS2; Matthew Wood, Ph.D.2; Moore M Amy, MD3; (1)Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, (2)Washington University School of Medicine, Saint Louis, MO, (3)Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO

Introduction: Neuropathic pain after nerve injury is not well understood, and current surgical treatment modalities for pain demonstrate variable success. The purpose of our study was to investigate the therapeutic effects of a proximal nerve crush on pain behavior following sciatic nerve transection injury.

Methods: Rats (n=16) were randomly assigned to experimental and sham therapy groups and received a sciatic nerve transection proximal to the trifurcation and the distal nerve was transposed. Nociception was evaluated by application of acetone to the mid-plantar surface of the hindpaw of both injured and uninjured limbs every two days for the first week and then weekly thereafter. Total time spent flinching (lifting or licking of the ventral surface) was recorded. At 2 weeks following transection, one experimental group received a crush injury 5-10 mm proximal to the site of transection, and the control group received a sham therapy. Behavior testing was continued following these therapies as before until 5 months post-therapy.

Results: Cold allodynia testing indicated that sciatic nerve transection resulted in elevated nociceptive pain behavior in the afflicted limb. A crush injury proximal to the site of transection two weeks after injury prevented development of cold allodynia hypersensitivity as compared to sham controls. This response was sustained for the duration of the experiment (five months).

Conclusions: These findings suggest that a proximal crush injury may be used therapeutically to prevent neuropathic pain following nerve injury, and could potentially provide an adjunctive strategy of treatment and/or prevention of painful neuromas.

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