Pain Management

Courtesy of The Leeds Teaching Hospital

Brachial plexus injuries can be very painful.  This pain can be divided into two stages depending on how long it lasts.

Acute pain

The initial pain that you feel immediately after your injury.  Usually this will last for a few weeks.

Chronic pain

Pain that lasts for longer than three months.

You may feel pain both in your neck and down into your arm.  The severity and type of damage that you have suffered often determines the amount of pain that you experience.  The damage to the nerves may cause them to ‘misfire’ and send out pain signals.  This sort of pain is often called Neuropathic Pain.

These nerves may also cause areas of your skin to feel very sensitive.  Normal touch, such as the brushing of clothing against your skin, can feel extremely painful.  This is call allodynia.

With this type of injury, pain can often develop into a long-term problem and can be difficult to manage. Your treatment may depend on which type of pain you feel and the length of time that it may last.

What treatments could I expect?

Please Note: The following treatments are given as a guide only.  Your own pain treatment may depend on the nature of your particular injury and clinical pain.

Medication

Neuropathic pain often responds better to special medicines, which have different actions from normal pain killers.  However, normal pain killers are still used and can be effective in many cases (i.e. Co-codamol, paracetamol or ibuprofen).

Gabapentin

Gabapentin is used to treat neuropathic pain.  Gabapentin was originally used in epilepsy but was found to help in neuropathic pain.  Gabapentin works by helping to reduce nerve excitability, which in turn helps to reduce pain signals being produced by the damaged nerves.

Unlike many pain control medicines, Gabapentin may take several weeks to start working and needs to be increased slowly to help reduce side-effects.

Amitriptyline

Amitriptyline may also be used in managing your pain.  Amitriptyline was originally used as an anti-depressant but was found to be helpful in pain control in lower doses.  Amitriptyline is usually taken at night, usually two hours before you sleep.  It can make you drowsy and the dose needs to be adjusted to minimize this effect.

Injections or Nerve Blocks

An injection or nerve block in the affected area may be beneficial in some people.

Usually a mixture of local anaesthetic and steroid is injected near the damaged nerves where is numbs the area helping to block pain signals.  Injections or nerve blocks can last between several hours and several months.  Unfortunately, in some cases, this is not an effective treatment.

Managing daily activity

In some cases it is not always possible to completely eradicate the pain resulting from a brachial plexus injury; however, it can often be reduced to a level which is better to manage.

As well as using medicines and treatments, adjusting your daily activities and strategies can help you cope better with your pain.  Important techniques in managing pain include pacing activity, relaxation, exercise and goal setting.