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Shoulder / Arm / Forearm / Hand - Postherpetic neuralgia / chronic pain after shingles
An important point needs to be made up front with the development of chronic pain after traumatic injury or some type of surgical procedure. It matters little to the body whether damage to nerves is sustained during the violence of a motorcycle crash or in the controlled, sterile environment of the operating room. At the end of the day, either mechanism (trauma or surgery) can be an effective way to damage peripheral nerves. Both trauma and surgery can produce lacerations, crush injuries, and stretch-traction injuries to peripheral nerves. The end result tends to be the same…chronic nerve pain.
Lacerating (cutting) or crushing a nerve are fairly intuitive concepts to understand in terms of how they produce nerve injury. Both of these injury mechanisms tend to result in the formation of a painful neuroma at the location of nerve injury. If the nerve in question performs an important motor (moving muscles) or sensory function to a specific part of the body, the hand for example, then repair of the nerve, possibly involving the use of nerve grafts is usually attempted. If on the other hand, the damaged nerve only provides sensation to an unimportant patch of skin, then disconnecting the nerve and employing special techniques to prevent recurrence of the painful neuroma may be the most effective option.
More difficult to grasp is the stretch-traction mechanism of nerve injury and how a seemingly minor event can sometimes produce devastating clinical symptoms. With stretch-traction injuries, the injury to the nerve can be more widespread leading to the development of nerve compression at multiple points along the course of the nerve. These compression points are not located randomly but tend to occur at locations of anatomic narrowing or tight spaces where the nerve normally passes through. In situations like these, something as innocuous as a “sprained ankle” can lead to excruciating pain throughout the entire leg, for example.
There are literally thousands of nerves throughout the body and any type of injury mechanism, whether it be as serious as a crush injury to the pelvis with multiple fractures or as minor as a needle stick to start an IV in the arm, has the potential to damage peripheral nerves and cause chronic pain.
These types of nerve injuries after trauma or surgery are so common, in fact, that patients who continue to experience significant pain 6 beyond six months should be considered to have an undocumented peripheral nerve injury until proven otherwise. This assumes that the original problem has been treated correctly and that complications such as infection, etc., have been ruled out first.
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