Brachial plexus avulsion neuropathic refractory pain: association of spinal cord stimulation and DREZotomy for complex pain

A 52-year-old male was involved in a car accident 30 years ago. He presented with complete motor paralysis of the left upper limb. This evolved into severe neuropathic pain (mainly shocking and burning sensation) distributed from C5 to T1 dermatomes. He was first treated with spinal cord stimulation (SCS), which did not show efficacy for pain control, maintaining high visual analog scale (VAS) scores. He then received complementary treatment with left cervical DREZotomy to mitigate suffering and preserve SCS function to control “mirror pain.”The video can be found here: https://youtu.be/iTvbLAZ3odM

Atypical bodily self-awareness in vicarious pain responders

Vicarious perception refers to the ability to co-represent the experiences of others. Prior research has shown considerable inter-individual variability in vicarious perception of pain, with some experiencing conscious sensations of pain on their own body when viewing another person in pain (conscious vicarious perception/mirror-pain synaesthesia). Self–Other Theory proposes that this conscious vicarious perception may result from impairments in self–other distinction and maintaining a coherent sense of bodily self. In support of this, individuals who experience conscious vicarious perception are more susceptible to illusions of body ownership and agency. However, little work has assessed whether trait differences in bodily self-awareness are associated with conscious vicarious pain. Here we addressed this gap by examining individual difference factors related to awareness of the body, in conscious vicarious pain responders. Increased self-reported depersonalization and interoceptive sensibility was found for conscious vicarious pain responders compared with non-responders, in addition to more internally oriented thinking (associated with lower alexithymia). There were no significant differences in trait anxiety. Results indicate that maintaining a stable sense of the bodily self may be important for vicarious perception of pain, and that vicarious perception might also be enhanced by attention towards internal bodily states. This article is part of a discussion meeting issue ‘Bridging senses: novel insights from synaesthesia’.

Usefulness of Cordotomy in Patients With Cancer Who Experience Bilateral Pain

BACKGROUND: Although mirror pain occurs after cordotomy in patients experiencing unilateral pain via a referred pain mechanism, no studies have examined whether this pain mechanism operates in patients who have bilateral pain. OBJECTIVE: To assess the usefulness of cordotomy for bilateral pain from the viewpoint of increased pain or new pain caused by a referred pain mechanism. METHODS: Twenty-six patients who underwent percutaneous cordotomy through C1-C2 for severe bilateral cancer pain in the lumbosacral nerve region were enrolled. Pain was dominant on 1 side in 23 patients, and pain was equally severe on both sides in 3 patients. Unilateral cordotomy was performed for the dominant side of pain, and bilateral cordotomy was performed for 13 patients in whom pain on the nondominant side developed or remained severe after cordotomy. RESULTS: After unilateral cordotomy, 19 patients (73.1%) exhibited increased pain, which for 14 patients was as severe as the original dominant pain. After bilateral cordotomy, 7 patients (53.4%) exhibited new pain, which was located cephalad to the region rendered analgesic by cordotomy and was better controlled than the original pain. No pathological organic causes of new pain were found in any patient, and evidence of a referred pain mechanism was found in 3 patients after bilateral cordotomy. CONCLUSION: These results show that a referred pain mechanism causes increased or new pain after cordotomy in patients with bilateral pain. Nevertheless, cordotomy can still be indicated for patients with bilateral pain because postoperative pain is better controlled than the original pain.