The purpose of this study was to evaluate the opinions and practices of peripheral nerve surgeons regarding assessment and treatment of pain in patients following nerve injury. Surgeons with expertise in upper extremity peripheral nerve injuries and members of an international peripheral nerve society were sent an introductory letter and electronic survey by email (n=133). Seventy members responded to the survey (49%) and 59 surgeons completed the survey (44%). For patients referred for motor or sensory dysfunction, 31 surgeons (52%) indicated that they always formally assess pain. In patients referred for pain, 44 surgeons (75%) quantitatively assess pain using a verbal scale (n=24) or verbal numeric scale (n=36). The most frequent factors considered very important in the development of chronic neuropathic pain were psychosocial factors (64%), mechanism of injury (59%), workers' compensation or litigation (54%), and iatrogenic injury (48%). In patients more than 6 months following injury, surgeons frequently see: cold sensitivity (54%), decreased motor function (42%), paraesthesia or numbness (41%), fear of returning to work (22%), neuropathic pain (20%), and emotional or psychological distress (17%). Only 52% of surgeons who responded to the survey always evaluate pain in patients referred for motor or sensory dysfunction. Pain assessment most frequently includes verbal patient response, and assessment of psychosocial factors is rarely included. Predominately, patient-related factors were considered important in the development of chronic neuropathic pain.
AbergMLjungbergCEdinEJenmalmPMillqvistHNordhE. Considerations in evaluating new treatment alternatives following peripheral nerve injuries: A prospective clinical study of methods used to investigate sensory, motor and functional recovery. J Plast Reconstr Aesthet Surg.2007;60:103–13. doi: 10.1016/j.bjps.2006.04.019.
2.
Ahmed-LabibMGolanJDJacquesL. Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery.2007;61:1016–23.
3.
AklEAMarounNKlockeRAMontoriVSchunemannHJ. Electronic mail was not better than postal mail for surveying residents and faculty. J Clin Epidemiol.2005;58:425–9. doi: 10.1016/j.jclinepi.2004.10.006.
4.
AschDAJedrziewskiMKChristakisNA. Response rates to mail surveys published in medical journals. J Clin Epidemiol.1997;50:1129–36. doi: 10.1016/S0895-4356(97)00126-1.
5.
BentolilaVNizardRBizotPSedelL. Complete traumatic brachial plexus palsy. Treatment and outcome after repair. J Bone Joint Surg.1999;81-A:20–8.
6.
BermanJSBirchRAnandP. Pain following human brachial plexus injury with spinal cord root avulsion and the effect of surgery. Pain.1998;75:199–207. doi:10.1016/S0304-3959(97)00220-0.
7.
BertelliJAGhizoniMF. Transfer of the accessory nerve to the suprascapular nerve in brachial plexus reconstruction. J Hand Surg.2007;32A:989–98.
8.
BertelliJAGhizoniMF. Pain after avulsion injuries and complete palsy of the brachial plexus: The possible role of nonavulsed roots in pain generation. Neurosurgery.2008;62:1104–14.
9.
BirchRBonneyGWynn ParryCB. Surgical Disorders of the Peripheral Nerves. Edinburgh: Churchill Livingstone; 1998.
10.
BlalockRRDialTH. Assessing sample representativeness in surveys of physicians. Eval Health Prof.1990;13:364–6. doi: 10.1177/016327879001300306.
11.
BraithwaiteDEmeryJDe LusignanSSuttonS. Using the Internet to conduct surveys of health professionals: a valid alternative?Fam Pract.2003;20:545–51. doi:10.1093/fampra/ cmg509.
12.
BruxelleJTraversVThiebautJB. Occurrence and treatment of pain after brachial plexus injury. Clin Orthop Relat Res.1988; 237:87–95.
13.
CarlssonICederlundRHolmbergJLundborgG. Behavioural treatment of post-traumatic and vibration-induced digital cold sensitivity. Scand J Plast Reconstr Surg Hand Surg.2003;37:371–8. doi:10.1080/02844310310013055.
14.
CarlssonICederlundRHoglundPLundborgGRosenB. Hand injuries and cold sensitivity: reliability and validity of cold sensitivity questionnaires. Disabil Rehabil.2008;30:1920–8. doi:10.1080/09638280701679705.
15.
ChuangDCCYehM-CWeiF-C. Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients. J Hand Surg.1992;17A:822–8.
16.
ChuangDCEpsteinMDYehMCWeiF-C. Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients. J Hand Surg.1993;18A:285–91.
17.
ChuangDCCLeeGWHashemFWeiF-C. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg.1995;96:122–8. doi:10.1097/00006534-199507000-00019.
18.
CocitoDPaolassoITavellaAPoglioFCiaramitaroPScarmozzinoA. Pain affects the quality of life of neuropathic patients. Neurol Sci.2006;27:55–160. doi:10.1007/s10072-006-0660-5.
19.
CollinsEDNovakCBMackinnonSEWeisenbornSA. Long term follow-up of cold intolerance after nerve injury. J Hand Surg.1996;21A:1078–85.
20.
CraigenMKleinertJMCrainGMMcCabeSJ. Patient and injury characteristics in the development of cold sensitivity of the hand: a prospective cohort study. J Hand Surg.1999;24A:8–15.
CullWLO'ConnorKGSharpSTangSS. Response rates and response bias for 50 surveys of pediatricians. Health Serv Res.2005;40:213–26. doi:10.1111/j.1475-6773.2005.00350.x.
23.
CummingsSMSavitzLAKonradTR. Reported response rates to mailed physician questionnaires. Health Serv Res.2001; 35:1347–55.
24.
DrummondFJSharpLCarsinA-EKelleherTComberH. Questionnaire order significantly increased response to a postal survey sent to primary care physicians. J Clin Epidemiol.2008;61:177–85. doi:10.1016/j.jclinepi.2007.04.012.
25.
FreedlanderE. The relationships between cold intolerance and cutaneous blood flow in digital replantation patients. J Hand Surg.1986;11B:15–9.
26.
GilronIWatsonPNCahillCMMoulinDE. Neuropathic pain: a practical guide for the clinician. CMAJ.2006;175:265–75. doi: 10.1503/cmaj.060146.
27.
GrahamBSchofieldM. Self-reported symptoms of cold intolerance in workers with injuries of the hand. Hand.2008;3 (3):203–9.
28.
HtutMMisraPAnandPBirchRCarlstedtT. Pain phenomena and sensory recovery following brachial plexus injury and surgical repairs. J Hand Surg.2006;31B:596–605.
29.
IrwinMSGilbertSEATerenghiGSmithRWGreenCJ. Cold intolerance following peripheral nerve injury Natural history and factors predicting severity of symptoms. J Hand Surg.1997;22B: 308–16.
30.
JaquetJ-BLuijsterburgAJMKalmijnSKuypersPDLHofmanAHoviusSER. Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity. J Trauma.2001;51:687–92. doi:10.1097/00005373-200110000-00011.
31.
JensenMPChodroffMJDworkinRH. The impact of neuropathic pain on health-related quality of life: Review and implications. Neurology.2007;68:1178–82. doi:10.1212/01.wnl. 0000259085.61898.9e.
32.
KatoNHtutMTaggartMCarlstedtTBirchR. The effects of operative delay on the relief of neuropathic pain after injury to the brachial plexus. J Bone Joint Surg.2006;88B:756–9.
33.
KellermanSEHeroldJ. Physician response to surveys. Am J Prev Med.2001;20:61–7. doi:10.1016/S0749-3797(00)00258-0.
34.
KimDHChoY-JTielRLKlineDG. Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center. J Neurosurg.2003;98:1005–16.
35.
LeechavengvongsSWitoonchartKUerpairojkitCThuvasethakulPKetmalasiriW. Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases. J Hand Surg.1998;23A:711–6.
36.
LeechavengvongsSWitoonchartKUerpairojkitCThuvasethakulP. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg.2003;28A:633–8.
37.
LeslieLL. Are high response rates essential to valid surveys?Soc Sci Med.1972;1:323–34.
38.
MackinnonSENovakCBMyckatynTMTungTH. Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer. J Hand Surg.2005;30A:978–85.
39.
MerskeyHBogdukN. Classification of chronic pain. Seattle: IASP Press; 1994.
40.
NathRKLyonsABBietzG. Physiological and clinical advantages of median nerve fascicle transfer to the musculocutaneous nerve following brachial plexus root avulsion injury. J Neurosurg.2006;105:830–4. doi:10.3171/jns.2006.105.6.830.
41.
NovakCBMackinnonSETungTH. Patient outcome following a thoracodorsal to musculocutaneous nerve transfer for reconstruction of elbow flexion. Br J Plast Surg.2003;55:416–9. doi:10.1054/bjps.2002.3859.
42.
SamiiMBear-HenneySLudemanWTatagibaMBlomerU. Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions. Neurosurgery.2001;48:1269–77. doi:10.1097/00006123-200106000-00016.
43.
SobalJFerentzKS. Comparing physicians' responses to the first and second mailings of a questionnaire. Eval Health Prof.1989; 12:329–39. doi:10.1177/016327878901200307.
44.
TungTHNovakCBMackinnonSE. Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries. J Neurosurg.2003;98:313–8.
45.
VanGeestJBJohnsonTPWelchVL. Methodologies for improving response rates in surveys of physicians: A systematic review. Eval Health Prof.2007;30:303–21. doi:10.1177/ 0163278707307899.
