How is Nerve Pain Treated Surgically?

The type of procedure depends on the location and cause of the pain. In many instances, the pain results from compression of (pressure on) a specific nerve or group of nerves. In such cases, relieving the pressure relieves the pain. This can usually be accomplished through relatively small incisions during an outpatient operation. In other cases, the nerves may need to be divided and rerouted. This can result in a limited area of numbness of the skin — often a welcome trade-off for the pain!


Surgery for Nerve Compression Pain

Nerves do not like to be “squeezed’.  There are some very narrow areas that nerves pass through – these areas are set-ups for compression of the nerve due to swelling or bruising from an injury, after surgery, or sometimes spontaneously. Examples of these types of compressions are carpal tunnel syndrome, common peroneal nerve, piriformis syndrome, lateral femoral cutaneous nerve, etc.  If it is determined that your pain is due to compression of a nerve, an operation could be performed to relieve the pressure on the nerve.  The tight space that the nerve goes through is opened surgically, giving it needed room to conduct signals normally, get good blood flow, and move normally.


Surgery for Nerve Injury Pain – Caused by Stretching, Cutting, Scar Tissue, etc.

Every operation has the potential to cause chronic nerve pain.  By cutting through the tissues to correct another issue, small (often unseen nerves) can be cut or damaged.  Retraction on tissues during surgery can stretch small nerves past their ‘breaking point’.  After surgery, as tissues heal, nerves can be caught up in scar tissue, causing them to be pulled on every time the patient moves that area of the body.  These injured nerves then send abnormal pain signals to the brain, causing chronic pain.

It is usually not possible to “fix” small nerves that are causing chronic pain, back to their original state of function.  However, once the injured nerve is identified, surgeons can disconnect the nerves up-stream from the injury.  This significantly decreases, or even eliminates, the chronic pain.  An area of numbness is the trade-off, in place of the pain.  Most patients are happy to make this trade!

 

RPNI and DSI for Prevention of Pain Recurrence

Nerve resection has high success rates in treating nerve injury pain – around 80%, depending on the individual patient.  In order to increase the chances for success even further, special treatments have recently been developed to “cap” the end of the cut nerves. Grafts of nearby muscle or skin are often placed around the ends of the nerve during surgery to prevent them from regrowing and causing pain again.  These procedures, developed and pioneered at the University of Michigan, are called Regenerative Peripheral Nerve Interface (RPNI – muscle grafts) and Dermatosensory Peripheral Nerve Interface (DSPNI – skin grafts).  The grafts are usually taken from nearby tissues, without additional harm to the patient.  The goal is to give the new ends of the nerves something to grow into, thereby preventing the recurrence of nerve pain. These techniques have been used to treat nerve pain and phantom pain due to amputations, surgery and injury all over the body.