Neuropathic pain change after brachial plexus reconstruction: Predictive value of root avulsion pattern, analgesic use, and motor recovery

J Plast Reconstr Aesthet Surg. 2026 Sep 24;123:71-80. doi: 10.1016/j.bjps.2026.09.039. Online ahead of print.

ABSTRACT

BACKGROUND: Neuropathic pain following traumatic brachial plexus injury (BPI) is common, severe, and frequently refractory to pharmacologic therapy, particularly in case of root avulsion and deafferentation. Reconstructive procedures such as nerve grafting and nerve transfer have been primarily evaluated based on motor recovery; however, their effects on pain remain poorly defined. We evaluated predictors of pain improvement following brachial plexus reconstruction under a strict pain-tapering protocol.

METHODS: This single-center retrospective study included patients with BPI who underwent surgery between 2013 and 2025. Standardized pain assessments (S-LANSS, NPSI, VAS, and IMBPIQ) were evaluated preoperatively, post-analgesic, and postoperatively. Logistic regression was used to identify predictors of pain improvement (NPSI reduction>7.95 points), analgesic response, and motor recovery (MRC≥3), with significance set at p<0.05.

RESULTS: Among 102 patients (mean age 31.3 years; 79 men), the mean follow-up period was 51 months. Overall, 57.8% achieved meaningful motor recovery, whereas 50% achieved clinically meaningful pain improvement. Preoperative analgesic medications provided limited benefit, with only 22% achieving meaningful improvement. Multivariable analysis demonstrated that higher preoperative NPSI (OR 1.057, 95% CI 1.035-1.079, p<0.001) and postoperative motor recovery (OR 10.752, 95% CI 2.681-43.478, p<0.001) were independent predictors of postoperative pain improvement.

CONCLUSIONS: In patients with BPI, functional motor recovery is significantly associated with neuropathic pain improvement after nerve reconstruction, indicating that functional restoration may contribute to pain relief through reinnervation-dependent neural plasticity.

PMID:42843192 | DOI:10.1016/j.bjps.2026.09.039