NEUROPATHIC CHRONIC PAIN FOLLOWING TRAUMATHIC BRACHIAL PLEXUS TOTAL SECTION MANAGED BY TRANSDERMAL BUPRENORPHINE PATCH(TDS): ORIGINAL CASE REPORT

Male, 24 years old, total section of the brachial plexus, Tinel/B. Horner signs: +. Suture of the accessory on suprascapular nerve, front and rear, and a wrapping of four 8 cm junctions, between C6 and the branches of the SPT, has been acted. Burning, continuous pain, VAS8, and clusters of intermittent shocks, VAS9, begun after surgery. Pain was, initially, treated with: carbamazepin 200 mg. SR/bid, amitriptilin 25 mg, tramadol 100 mg SRbid increasing of 100 mg, every two days, up to 400 mg/die; RD: tramadol drops 50 mg. Two weeks after, because of pain relief absence, tramadol was replaced by TDS37. 5 mcgr/h with titration scheme: 1/4 for 7, 1/2 for 21, 1 for 28 days; RD: buprenorphin s.l. 0.2mg. Weekly, for a period of 8 weeks, have been checked: Vas, side effects (number of episodes) and number of RD. Results: see enclosed figure. Conclusions: a difficult case of neuropathic chronic pain, refractory to the theraphy, has founded significative improvement by TDS that, joint with anticonvulsant and triciclic antidepressant drugs, has allowed significative basal pain control and reduction of the number of the breakthrough pain episodes