Author/Editor		Prestor, B; Dolenc, VV
Title		Clinical results of DREZ-treatment in deafferentation pain
Type		članek
Source		In: Kepplinger B, Pernak JM, Ray AL et al, eds. Pain - clinical aspects and therapeutical issues. Part 2. Linz: Edition Selva Verlag,
Publication year		1993
Volume		str. 17-23
Language		eng
Abstract		15 patients were operated on for intractable deafferentation pain. The clinical study included 12 patients with a brachial plexus avulsion lesion, 1 patients with phantom pain, 1 patient with postherpetic pain and 1 patient with reflex symphatic dystrophy syndrom. Using bipolar forceps, a junctional coagulation lesion in the region of the dorsal root entry zone (DREZ) was made. We believe that the junctional coagulation lesion in a depth of 2-3 mm includes all the structures important for the generation of deafferentation pain in the DREZ region extending to the Vlth Rexed's lamina. In the follow-up period from 12 to 36 months we had good results as in 87 percent of our patients we achieved more than 50 percent pain relief and excellent results with more than 70 percent pain relief in 80 percent of our patients. In 6 patients (42.8 percent) we obtained complete pain relief. We achieved our best results with patients who had suffered from deafferentation pain for many years. In order to achieve effective pain relief, the duration of deafferentation pain should have lasted longer than a year. It seems that previous neurosurgical procedures other than DREZ microcoagulation lead to changes in the dorsal horn pain control and subsequent development of abnormal pain mechanisms at higher levels of the central nervous system. Postoperative complications were rare. Three patients showed discrete and transient neurological deficits indicating that the dorsal columns system and dorsal spinocerebellar tract had been affected. There were no signs of pyramidal tract involvement. Clinical results of the junctional microcoagulation DREZ lesion in the treatment of intractable deafferentation pain are very promising.
Descriptors		PAIN, INTRACTABLE SPINAL NERVE ROOTS TREATMENT OUTCOME NEUROSURGERY PERIPHERAL NERVOUS SYSTEM DISEASES PAIN, INTRACTABLE