Seeing patients in the office who are suffering from chronic pain with no obvious anatomical cause can be frustrating and disappointing; all physicians want to help their patients return to the activities they love. If the cause of the pain isn’t apparent through an X-ray, CT scan, or MRI, consider this: Could the problem lie in the peripheral nerves?
It’s in our nature as physicians to focus on what we can clearly see and objectively measure. Neuropathic pain, however, while not visible on an X-ray and challenging to discern on other imaging, is every bit as real as a fracture or laceration—and our current treatment options can be surprisingly effective. I believe that it is our obligation as physicians to dig deeply in order to identify and address the root cause of our patients’ pain.
Identifying the Problem
Many providers are not well-versed in the anatomy of the peripheral nervous system—the intricacies of the neural wiring throughout our legs, arms, hands, and feet. Peripheral nerve problems are common, and often are the result of prior surgery, traumatic injury, or amputation.
As a hand and peripheral nerve surgeon specializing in extremity reconstruction, I regularly encounter patients who feel that they have run out of options for treatment of their chronic pain. They commonly describe intense feelings of burning pain, shooting pain, and electrical-type pain. Many patients have seen several physicians who have not been able to offer a definitive solution for their pain.
Nerve injuries can stem from prior surgery, as large or small nerves may be injured during the surgical incision and approach. Left unaddressed, some injured nerves can lead to painful nerve endings called neuromas. A relatively high percentage of patients experience chronic neuropathic pain after surgery. Often, it is possible to determine within the first few minutes of meeting with a patient whether there might be an anatomic cause—and a potential surgical solution—for their chronic pain. Many patients with a treatable nerve injury never see a clinician who can identify, diagnose, and treat the root cause of their problem.
Improving Patients’ Lives & Raising Awareness
We, as peripheral nerve surgeons, now have a toolbox of effective surgical options for treating nerve pain at its source—regardless of the time course or the anatomic location of injury. Painful neuromas can be removed, and we have solutions to help provide the nerve ending with a functional destination, thereby mitigating neuropathic pain.
Recently, I had the honor of serving as faculty for the Esser Masterclass Peripheral Nerve Surgery course in Rotterdam, Netherlands, with the Global Nerve Foundation. During this educational meeting, I worked with the next generation of peripheral nerve surgeons on innovative surgical techniques for resolving neuropathic pain. In general, there is limited awareness of nerve pain—and even fewer surgeons who are trained in surgery for neuropathic pain—but instructional courses are part of the solution.
I have built my practice around surgical reconstruction of the extremities and of the peripheral nervous system. One of the most rewarding parts of my work is helping patients who have chronic nerve pain, and who have been told by other providers that there were no other treatment options or opportunities to improve their pain. Another incredible aspect of my practice is the opportunity to educate other clinicians on the anatomic causes of nerve pain and potential surgical solutions. We owe it to our patients to thoroughly investigate the cause of their pain, and to learn about the contemporary solutions that can be provided. If you are interested in learning more, I encourage you to connect with colleagues who specialize in peripheral nerve surgery.
