Problems of diagnosis and treatment of chronic pain syndrome in patients with variants of the structure of peripheral nerves. A series of clinical cases

Abstract

AIM: To assess the presence of variants of the structure of peripheral nerves as possible risk factors for chronic pain syndrome on the example of a series of clinical cases.

MATERIALS AND METHODS: The systematization and analysis of data from domestic and foreign literature on pathophysiology, clinic, diagnosis and treatment of complex regional pain syndrome has been carried out. Research method: system analysis, presentation of a series of clinical cases.

RESULTS: A series of clinical cases is presented. The main risk factors for chronic pain syndrome are presented. The conditions and diseases that need to be differentially diagnosed if complex regional pain syndrome is suspected are systematized: tunnel syndromes (carpal tunnel syndrome), diabetic polyneuropathy, HIV polyneuropathy, postherpetic neuralgia, neurogenic claudication/lumbar stenosis, central post-stroke pain, upper thoracic syndrome apertures.

CONCLUSION: Today, practitioners and neurophysiologists are not sufficiently aware of the existence of interneural anastomoses and features, typical electroneuromyographic signs, as a result of which in most cases the obtained electroneuromyographic data are interpreted erroneously. Variants of the structure of nerves can give an incorrect clinical picture of the condition of peripheral nerves and lead to untimely diagnosis and treatment of chronic pain syndrome, complex regional pain syndrome. Improvements in diagnostic methods, as well as widely introduced high-tech examination methods, in particular electroneuromyography, magnetic resonance imaging and ultrasound, are helping to increase the frequency of detection of abnormalities in the structure of peripheral nerves. In the presented clinical cases, patients had structural variants that gave an incorrect clinical picture of the condition of the peripheral nerves and led to untimely diagnosis and treatment — the development of chronic pain syndrome.

Keywords

chronic pain / CRPS / ENMG / interneural anastomoses / traumatic neuropathy / ultrasound / variants of nerve structure

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