Table 5. Common Pain Syndromes Due to Peripheral Nerve Injury
Pain syndrome | Associated signs and symptoms | Affected nerves |
---|---|---|
Tumor infiltration of a peripheral nerve | Constant, burning pain with dysesthesia in an area of sensory loss | Peripheral |
Pain is radicular and often unilateral | ||
Postradical neck dissection | Tight, burning sensation in the area of sensory loss | Cervical plexus |
Dysesthesias and shocklike pain may be present | ||
Second type of pain may occur mimicking a drooped shoulder syndrome | ||
Postmastectomy pain | Tight, constricting, burning pain in the posterior arm, axilla, and anterior chest wall | Intercostobrachial |
Pain exacerbated by arm movement | ||
Postthoracotomy pain | Aching sensation in the distribution of the incision with sensory loss with or without autonomic changes | Intercostal |
Often exquisite point tenderness at the most medial and apical points of the scar with a specific trigger point | ||
Secondary reflex sympathetic dystrophy may develop | ||
Postnephrectomy pain | Numbness, fullness, or heaviness in the flank, anterior abdomen, and groin | Superficial flank |
Dysesthesias are common | ||
Postlimb amputation | Phantom limb pain usually occurs after pain in the same site before amputation | Peripheral endings and their central projections |
Stump pain occurs at the site of the surgical scar, several months to years after surgery. It is characterized by a burning dysesthetic sensation that is exacerbated by movement | ||
Chemotherapy-induced peripheral neuropathy | Painful paresthesias and dysesthesias | Distal areas of peripheral (e.g., polyneuropathy) |
Hyporeflexia | ||
Less frequently: motor and sensory loss; rarely: autonomic dysfunction | ||
Commonly associated with the vinca alkaloids, cisplatin, and Taxol | ||
Radiation-induced peripheral nerve tumors | May promote malignant fibrosarcoma | Superficial and deep |
Painful, enlarging mass in a previously irradiated area | ||
Patients with neurofibromatosis more susceptible | ||
Cranial neuropathies | Severe head pain with cranial nerve dysfunction | Cranial V, VII,IX, X, XI, XII are most common |
Leptomeningeal disease | ||
Base of skull metastasis | ||
Acute and postherpetic neuropathy | Painful paresthesia and dysesthesia | Thoracic and cranial (VI) are most common |
Constant burning and aching pain | ||
Shocklike paroxysmal pain | ||
Immunosuppression from disease or treatment is a risk factor; postherpetic neuropathy incidence increases with age |
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