Post-Traumatic Neuralgia

Peripheral nerve damage is classified into three categories based on severity: neurapraxia, axonotmesis, and neurotmesis. Peripheral nerve damage is the second most common category of in anesthesia related complications. The “double-crush” phenomenon is a term used to describe preexisting neurological injury that limits the neurological reserve of affected nerves. The risk of clinical deficits from a subsequent nerve injury is increased with the double crush phenomenon. Noniatrogenic traumatic nerve injury is most common in young adult males. Management of post-traumatic neuralgia often involves consultation with pain medicine, neurology, and neurosurgery. This multidisciplinary approach has two central goals, restoring nerve function and minimizing chronic neuropathic pain. Pharmacotherapy and procedural therapies are the treatments for neuropathic pain. Pharmacological agents include secondary amine tricyclic antidepressants (e.g., nortriptyline, desipramine), calcium channel α‎-2-δ‎ ligand anticonvulsants (e.g., pregabalin, gabapentin), opioids, ketamine, and topical lidocaine. Procedural interventions may be indicated when pain remains refractory to multiple pharmacological therapies. Procedures include nerve blocks, ablation, and neurostimulation, designed to interfere with, interrupt, or modulate pain pathways.