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DREZ Lesioning Deafferentation Pain — FRCA Final MCQ

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HardPain MedicineDREZ Lesioning Deafferentation PainFRCA Final

A 55-year-old man (ASA II) has severe chronic neuropathic pain from a brachial plexus avulsion injury following a motorcycle accident 5 years ago. He has failed all first-line neuropathic pain medications, spinal cord stimulation, and psychological therapies. Which intervention may be considered as a last resort for intractable deafferentation pain?

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Correct answer: C — Peripheral nerve stimulation

Dorsal root entry zone (DREZ) lesioning is a neurosurgical intervention that may be considered for intractable deafferentation pain following brachial plexus avulsion, where the pain arises from abnormal activity in the dorsal horn neurons deprived of their normal afferent input. DREZ lesioning destroys the hyperactive neurons in Rexed laminae I-V. It has demonstrated efficacy specifically for brachial plexus avulsion pain (60-80% pain relief). This is a highly specialised procedure performed in only a few neurosurgical centres.

Reference: Faculty of Pain Medicine – 2023 – Interventional pain procedures; RCOA – 2023 – Pain medicine curriculum