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.
Management of your pain whilst you are in hospital is very important. A detailed information leaflet called ‘Pain Relief after your Operation’ is available in each ward area (applies to Leeds General Hospital). This describes a variety of methods that can be used to manage the type of pain that you may experience after an operation / injury. If your pain is difficult to manage, the Acute Pain Team may be called to visit you whilst you are in hospital. They may suggest different types of drugs or treatments to help you manage your pain.
If your pain remains a persistent problem, you may then be referred as an outpatient to either the Leeds Chronic Pain Management Service or your local chronic pain service.
Leeds Chronic Pain Management Service
The team has many different professionals including consultants, nurses, pharmacists, psychologists and physiotherapists. They are all specialists in pain management and will work together to provide a full assessment of your pain and develop an appropriate treatment plan.
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 minimise 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.
Further information on any of these techniques can be obtained by contacting one of the pain support groups listed below.
Action on Pain!
20 Necton Road, Little Dunham, PE32 2DN Ph. 0845 603 159 www.action-on-pain.co.uk
Pain Concern
PO Box 13256, Haddington, EH41 4YD Ph. 01620 822572 www.painconcern.org.uk