Scientific/Clinical Article| Volume 31, ISSUE 2, P184-194, April 2018

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Peripheral nerve injuries, pain, and neuroplasticity

  • Natalie R. Osborne
    Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada

    Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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  • Dimitri J. Anastakis
    Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada

    Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada

    Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Karen D. Davis
    Corresponding author. Krembil Research Institute, 399 Bathurst Street, Toronto Western Hospital, Room MP12-306, Toronto, Ontario, Canada M5T2S8, Canada. Tel.: (416) 6035662.
    Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada

    Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada

    Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author


      • Peripheral nerve injuries (PNIs) cause both structural and functional brain changes that may be associated with significant sensorimotor abnormalities and pain.
      • Neuroplasticity occurs following a PNI. Neuroplasticity can be studied and assessed using sensory testing techniques and neuroimaging.
      • Brain plasticity can provide an explanation for common symptoms including hypoesthesia, hyperalgesia, cold sensitivity, and chronic neurogenic pain.
      • Maladaptive neuroplasticity as well as psychological and personality characteristics impact treatment outcome.
      • Greater understanding of the brain's contribution to symptoms in recovering PNI patients could help guide rehabilitation strategies and inform the development of novel techniques to counteract these maladaptive brain changes and ultimately improve outcomes.



      Peripheral nerve injuries (PNIs) cause both structural and functional brain changes that may be associated with significant sensorimotor abnormalities and pain.

      Purpose of the Study

      The aim of this narrative review is to provide hand therapists an overview of PNI-induced neuroplasticity and to explain how the brain changes following PNI, repair, and during rehabilitation.


      Toward this goal, we review key aspects of neuroplasticity and neuroimaging and discuss sensory testing techniques used to study neuroplasticity in PNI patients.


      We describe the specific brain changes that occur during the repair and recovery process of both traumatic (eg, transection) and nontraumatic (eg, compression) nerve injuries. We also explain how these changes contribute to common symptoms including hypoesthesia, hyperalgesia, cold sensitivity, and chronic neurogenic pain. In addition, we describe how maladaptive neuroplasticity as well as psychological and personality characteristics impacts treatment outcome.

      Discussion and Conclusion

      Greater understanding of the brain's contribution to symptoms in recovering PNI patients could help guide rehabilitation strategies and inform the development of novel techniques to counteract these maladaptive brain changes and ultimately improve outcomes.


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      JHT Read for Credit

      Quiz: #536

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        PNIs cause
        • a.
          no brain changes, only peripheral changes
        • b.
          only structural brain changes
        • c.
          only functional brain changes
        • d.
          both functional and structural brain changes
      • #2.
        Referred pain is an example of
        • a.
          mild patient neurosis
        • b.
          failure of neural pathways to re-connect accurately following peripheral nerve laceration and repair
        • c.
        • d.
          transient temporal lobe misfiring
      • #3.
        The following are identified as possibly causing poor outcomes
        • a.
          maladaptive neuroplastic responses
        • b.
          vitamin C deficiencies
        • c.
          inadequate number of approved therapy visits
        • d.
          too conservative rehab interventions
      • #4.
        It is the authors’ hope that
        • a.
          hand therapists become more aggressive in treating PNI patients
        • b.
          greater understanding of the brain’s role in recovery from PNIs will lead to new and better treatment strategies
        • c.
          better surgical techniques will reduce the need for neuroplastic changes following PNIs
        • d.
          insurance companies will recognize the need for more complex therapies in treating PNI patients
      • #5.
        Personality characteristics may play a significant role in determining rehab outcomes following PINs
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.