The 2004 Annual Meeting (January 14-20, 2004) of OASYS_NEW

Not yet assigned to a slot - 12:28 AM

A Novel Model of Neuroma Pain

Belzberg AJ, Dorsi MJ, Chen L, and Meyer RA. Department of Neurosurgery, Johns Hopkins University, 600 N Wolfe St, 5-109 Meyer Building, Baltimore, MD, USA

Touching a neuroma causes pain in many neuropathic pain patients. In current animal models of neuropathic pain, hyperalgesia to mechanical or thermal stimuli is measured in the distribution of the injured nerve; direct mechanical stimulation of the neuroma is not usually done. We postulate that the neural mechanism of neuroma pain and hyperaglesia differ. Sprague-Dawley rats were randomly divided into one experimental group and three control groups: Group One represents the neuroma model group. The posterior tibial nerve was exposed in the region of the division into lateral and medial plantar branches, tightly ligated with silk suture and transected. The ligated nerve stump was tunneled subcutaneously across the anterior aspect of the leg to a position just superior to the lateral malleolus. This placed the neuroma well outside of the tibial nerve innervation territory. In Group Two, surgery was performed as described above, but the nerve was ligated and transected a second time at the entrance to the subcutaneous tunnel. In Group Three, the posterior tibial nerve was ligated and transected, but the nerve stump was left in place. A small piece of connective tissue was dissected, ligated and passed through the subcutaneous tunnel. In Group Four, the posterior tibial nerve was dissected free but left intact. Again, connective tissue was passed through the subcutaneous tunnel. Behavioral testing was performed in a blinded fashion. The suture was visualized through the skin and served as the target for application of mechanical stimuli. A 15 gm von Frey filament was applied to the target site for 2 s. A positive response was defined as a rapid withdrawal of the hindpaw, or slow withdrawal with licking or shaking of the hindpaw. The frequency of response to six applications of the von Frey probe was determined. Testing began 2 days postoperatively and continued for three months. Application of the von Frey probe to the test site near the lateral malleous led to behavioral signs of pain only for animals in the neuroma-model group. A significant increase in the behavioral response frequency was initially evident on post-operative day 3 and persisted throughout the duration of the study. In contrast, none of the three control groups exhibited a significant change in behavioral response frequency with respect to baseline or each other. We have developed a behavioral model of neuroma pain in which the neuroma is accessible but remote from the injured nerve distribution where hyperalgesia can occur.