Resurgent neuropathic discharge: an obstacle to the therapeutic use of neuroma resection?. Issue 2 (28th May 2022)

• Record Type: Journal Article
• Authors: Tal, Michael; Minert, Anne; Devor, Marshall
• Is Part Of: Pain. Volume 164:Issue 2(2023)
• Page Start: 349
• Page End: 361
• Publication Date: 2022-05-28
• Subjects: Dorsal root ganglion -- Ectopic discharge -- Nerve resection -- Neuroma -- Neuropathic pain -- Resurgent pain; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000002704
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Resecting a previously injured nerve in rats did not trigger resurgent ectopic neuropathic discharge or resurgent pain behavior, perhaps mitigating this concern in patients with pain. Abstract: Ectopic discharge ("ectopia") in damaged afferent axons is a major contributor to chronic neuropathic pain. Clinical opinion discourages surgical resection of nerves proximal to the original injury site for fear of resurgence of ectopia and exacerbated pain. We tested this concept in a well-established animal neuroma model. Teased-fiber recordings were made of ectopic spontaneous discharge originating in the experimental nerve-end neuroma and associated dorsal root ganglia in rats that underwent either a single transection (with ligation) of the sciatic nerve or 2 consecutive transections separated by 7, 14, 21, or 30 days. Ectopia emerged in afferent A and C fibers after a single cut with kinetics anticipated from previous studies. When resection was performed during the early period of intense A-fiber activity, a brief period of resurgence was observed. However, resection of neuromas of more than 14 days was followed by low levels of activity with no indication of resurgence. This remained the case in trials out to 60 days after the first cut. Similarly, we saw no indication of resurgent ectopia originating in axotomized dorsal root ganglion neuronal somata and no behavioral reflection of resurgence. In summary, we failed to validate the concern that proximal resection of a problematic nerve would lead to intense resurgent ectopic discharge and pain. As the well-entrenched concept of resurgence is based more on case reports and anecdotes than on solid evidence, it may be justified to relax the stricture against resecting neuromas as a therapeutic strategy, at least within the framework of controlled clinical trials.