Post-op neuropathy can be immune system attack on nerves: Immunosuppressive drugs may help

Areas of post-op pain, numbness, weakness are often actually an immune system attack on the nerves and can involve parts of the body seemingly unrelated to the surgery.

A new Mayo Clinic study found that nerve inflammation may cause the pain, numbness and weakness following surgical procedures that is known as postsurgical neuropathy – often days after surgery and even in seemingly unrelated parts of the body.

• The development of postsurgical neuropathies is typically attributed to compression or stretching of nerves during surgery.

• This new research shows that, in some cases, the neuropathy is actually caused by the immune system attacking the nerves and is potentially treatable with immunosuppressive drugs.

The study (“Post Surgical Inflammatory Neuropathy”) was published online Sep 15 in the journal Brain.

Postsurgical neuropathy is an uncommon complication of surgery. Peripheral nerves are the extensive network of nerves that link the brain and spinal cord (the central nervous system) to all other parts of the body.

When damaged by stretching, compression or inflammation, the peripheral nerve injury can interfere with communication between the brain and the rest of the body (muscles and sensation are controlled by the nerve).

Individuals with postsurgical neuropathy may experience loss of sensation, pain and muscle weakness.

"It is important that a person with postsurgical inflammatory neuropathy receive a diagnosis and treatment quickly. Understanding the role of inflammation in these patients' neuropathy can lead to appropriate immunotherapy and improvement of neurological symptoms and impairments," says Mayo neurologist P. James Dyck, MD, senior author of the study.

When Post-Surgery Neuropathy Doesn't Make Sense

As part of the research, Dr. Dyck and a team of Mayo Clinic researchers selected 23 patients who developed neuropathy within 30 days of a surgical procedure.

• According to Dr. Dyck, the neuropathy of these 23 patients did not make sense in terms of being caused by stretching or compression because the nerves damaged were usually in a different part of the body from the surgical site or the neuropathy occurred at least a few days after the surgery was over.

• The surgical procedures were orthopedic, abdominal, chest or dental.

• All the patients received a nerve biopsy, of which 21 demonstrated increased inflammation.

• Seventeen patients were treated over a three-month period with immunotherapy, and in all cases with follow-up the neuropathy impairments improved.

Allows for Accurate Diagnosis, Treatment

"This is exciting for patients because it allows for appropriate identification and accurate treatment of postsurgical neuropathy. Without showing inflammation on the nerve biopsies, we would have been unable to know the cause of the neuropathy," says Nathan Staff, MD, PhD, a Mayo Clinic neurologist and the first author of this study.

"It is logical for patients to believe that it was the surgeon's fault that they developed a neuropathy because it occurred after the surgery," says Dr. Dyck.

"However, in these cases, we have strong evidence that the neuropathies were not the surgeon's fault but were caused by the immune system attacking the nerves."

Source: Mayo Clinic news release, Sep 22, 2010

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3 thoughts on “Post-op neuropathy can be immune system attack on nerves: Immunosuppressive drugs may help”

  1. Ly45nn says:

    They never mentioned in the article what to do or what medicine works if this happens to you. Is it too late for help if it is 4 years later after the surgery. My daughter has this issue.

  2. FMoldtimer says:

    There is a link to the article in the text. It’s a free download (pdf) from the journal. There’s also a response to it, with a link at the end of the abstract. Be sure you read both.

    1) This is a very small study, and is in fact too small to have much statistical significance.

    2) There were no controls. They recruited post-surgical patients with diagnosed neuropathies, as opposed to setting up a group of presurgical patients to watch, so they had no control group from the outset. They also left no one in this post-surgical group untreated as a control, so have no idea which, if any, might have resolved on their own. A few were untreated, presumably for other reasons, but their outcomes are not reported.

    3) Diagnosis involved invasive testing, including nerve biopsies, which is unlikely to be done for most patients (see their comments at the very end of the paper about the lack of diagnostic testing in most post-surgical neuropathies, and the question as to which diagnostic measures should be considered generally appropriate). All cases were treated relatively quickly after they developed. The deterioration of nerve & muscle after long-standing inflammation may not allow of much treatment. All treated cases showed some improvement, but there is no way to determine how many might have improved on their own due to both the lack of a control group and small study size.

    4) Treatment in most cases involved IV methylprednisone. As with all steroid anti-inflammatories, this carries its own set of risks.

    The response article makes clear a lot of what needs to be done before anything suggested in this study will become the standard of care.

  3. Mishque says:

    I had this happen to me after a cystocopy, a very small operation. I have been in terrible pain for 4 years now. It is all because of my Fibromyalgia.

    I do, however, agree with everything stated in this article as after talking to various pain consultants I can totally understand that this can and does happen. I only wish I had known about these sorts of complications before I had the surgery because I could have dealt with the consequences a little better.

    It would be nice if someone could find a solution to it as it would make surgery for people like me a lot easier to contemplate.

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