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Age-Dependent Development Of Chronic Neuropathic Pain, Allodynia And Sensory Recovery After Upper Limb Nerve Injury In Children

DUNCAN D ATHERTON, OMEED TAHERZADEH, DAVID ELLIOT, PRAVEEN ANAND

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Forty-nine children with distal upper limb nerve injury were studied at a mean follow-up of 2 years 3 months. Patients who were aged 5 years or younger at the time of nerve injury (15/49) had no chronic neuropathic pain symptoms or allodynia. Patients with allodynia on quantitative sensory testing but no spontaneous pain (8/49) were all older than 5 years and those reporting spontaneous chronic neuropathic pain (5/49) were all older than 12 years at the time of injury. Previous studies of adults with similar nerve injuries report chronic hyperaesthesia in up to 40% of cases. Semmes–Weinstein monofilament testing showed a positive correlation between age at injury and abnormal sensory threshold ( r = 0.60, P<0.0001). These findings indicate that young children show better sensory recovery and are less likely to develop long-term chronic neuropathic pain syndromes than adults following nerve injury.