INCIDENCE, RISK FACTORS, AND RELIEF INTERVENTIONS OF DISTANT NEUROPATHIC PAIN FOLLOWING FOOT AND ANKLE SURGERY: A SYSTEMATIC LITERATURE REVIEW

Abstract

Background: Neuropathic pain is a phenomenon that is oftentimes experienced post-operatively. Unlike nociceptive pain, neuropathic pain is not derived from direct physical damage to the tissue but rather is consistent with a malfunctioning nervous system or nerve damage. It is often characterized as a chronic shooting or burning pain with the possibility of never going away. Moreover, the causes of this seemingly random nervous system malfunction have not yet clearly been identified, and the potential risk factors for the possibility of experiencing this pain are largely unexplored. Methods: A systematic review was conducted through PubMed. The initial search yielded 628 articles, from which 601 were excluded and 27 were included after the initial screening of the titles and abstracts. Eight articles were then eliminated, yielding 19 articles. The 19 articles that were chosen involved patients who experienced symptoms consistent with chronic neuropathic pain that underwent surgical intervention of the foot or ankle. Results: The incidence rates of patients experiencing neuropathic pain symptoms post-operatively varied from study to study, including 3%, 12.4%, 13.3%, 23%, and 24%. Risk factors included smoking, age (40-60 years old), psychological distress/negative mood, obesity, tourniquet pressure, prior surgery, and acute postoperative pain. One study found a higher correlation between ankle surgeries and neuropathic pain versus forefoot surgeries and neuropathic pain. There appeared to be no correlation between neuropathic pain and tourniquet placement, time the tourniquet was on prophylactic antibiotics, type of anesthesia, level of anesthesiology training, diabetes, hypertension, or dislocation. Types of treatment that provided promising results included ultrasound-guided radiofrequency ablation, sural nerve neurectomy, popliteal nerve blocks, peroneal nerve blocks, neurolysis, peripheral nerve stimulation, spinal cord stimulation, and VR (virtual reality). Conclusion: There is no definite answer as to whether a patient will or will not develop neuropathic symptoms. Patients should always be made aware of the possibility as well as their chances of developing neuralgia subsequent to foot or ankle surgery by their surgeon.