Perioperative Treatment of Neuropathic Pain (Nerve SPACE 2025)

Neuropathic pain following brachial plexus and peripheral nerve injury represents one of the most debilitating and least effectively treated sequelae of nerve trauma. Where are we now? Neuropathic pain affects a majority of patients with severe nerve injuries and is frequently more disabling than associated motor or sensory deficits. The current scientific understanding implicates maladaptive peripheral and central nervous system changes, including neuroma formation, nociceptor hyperexcitability, central sensitization, and cortical reorganization. Contemporary management relies on multimodal strategies incorporating rehabilitation, pharmacotherapy, psychological support, neuromodulation, and select surgical interventions; however, most patients experience only partial or temporary relief, underscoring the persistent gap between mechanistic insight and durable clinical benefit. Where do we need to go? There remains a critical need for more effective, durable, and patient-centered approaches to neuropathic pain. Improved stratification tools, including biologic, imaging, and electrophysiologic biomarkers, are required to guide personalized treatment selection. Existing preclinical models inadequately capture the psychosocial and functional dimensions of pain, limiting translational relevance. Future therapies must better integrate biological, technological, and psychosocial domains while prioritizing pain relief as an outcome equal in importance to motor and sensory recovery. How do we get there? Progress will depend on multidisciplinary collaboration that aligns surgical innovation, targeted pharmacologic therapies, neuromodulation technologies, and structured psychological support. One target for growth in the field will be establishing multicenter registries and consensus-built outcome measures, which will be essential to evaluate real-world effectiveness and inform best practices. Continued refinement of biologically rational surgical strategies, emerging neuromodulation platforms, and integrative rehabilitation tools offer a pathway toward care models that address both pain and function. Meaningful improvements in quality of life for patients with nerve injury–related neuropathic pain may be achieved.