Brachial plexus nerve consists of the anterior branch of the 5th-8th cervical nerves and the 1st thoracic nerve; sometimes the cervical 5 receives part of the nerve fibers of the cervical 4, and the thoracic 1 receives part of the fibers of the thoracic 2. Any injury to the nerves that make up the brachial plexus is known as brachial plexus nerve injury, and the brachial plexus injury is a kind of difficult to deal with peripheral nerve injuries, which often leads to serious dysfunctions of the upper limbs, resulting in lifelong disability and It has serious socio-economic impacts. Immediate or delayed pain and upper limb dysfunction occur after the injury, and the nature of the pain is burning, pressing, etc. Spontaneous pain, touch-evoked pain, and nociceptive sensitization can coexist, and it is a kind of chronic intractable neuropathic pain. RyanBailey et al. investigated 49 cases of brachial plexus nerve injury patients with painrating (10cmanalogscale) scale, and found that the average score of the patients’ pain was 5.1, which belonged to moderate pain; about 40% of the 49 patients had depression, which was much higher than the prevalence rate of 15%~19% in the general population. And patients with radicular avulsion injuries were more likely to have pain. In patients with brachial plexus injuries, the incidence of pain can be as high as about 70%.Ciaramitaro[10] reported that patients with radicular avulsion injuries of the brachial plexus were more likely to have neuropathic pain than patients with partial brachial plexus injuries in general. In addition to peripheral factors associated with the development of pain after brachial plexus avulsion injuries, a large body of evidence suggests that central nerve-related mechanisms also play an important role in the development of pain. CentralSensitization (CS) is an important mechanism that leads to amplification and prolongation of pain. Central sensitization increases the excitability of the sensory nervous system and leads to an increase in the individual’s sensitivity to painful stimuli (nociceptive hypersensitivity), and a decrease in the pain threshold (anamnestic pain), which usually extends beyond the injured innervation. In most cases, the pathophysiologic and clinical changes triggered by avulsion injuries are associated with spinal cord lesions, not just spinal ganglion injuries. For example, an experimental model of brachial plexus avulsion injury triggered more pronounced and prolonged bilateral mechanical and cold tactile pain that was not confined to the innervated area of the damaged nerve compared with an experimental model of compression and ligation, a phenomenon that confirms that symptoms after avulsion injuries are associated with central alterations, and suggests that the widespread pain cannot be explained simply by peripheral mechanisms or by central sensitization. Some patients with brachial plexus avulsion injuries still perceive pain and motor sensations in the affected limb, a phenomenon known as phantom limb pain (PLP). This is a specific type of neuropathic pain, also known as deafferentationPain. This type of pain is usually persistent, accompanied by intermittently worsening radiating pain toward the hand. The incidence of phantom limb pain after brachial plexus avulsion injury is 39.3% (the incidence of phantom limb pain in patients with amputation is 54-85%, and these phenomena are related to the poor remodeling of the cortical functional area in the area of avulsion injury or amputation. 1.Conservative treatment Including drug treatment, traditional Chinese medicine treatment, physical therapy, psychotherapy and so on. Drug treatment can achieve analgesic effect in a short time (mainly morphine, gabapentin, etc.). Physical therapy can help patients optimize gait and posture, improve muscle strength and body functions (including transcutaneous electrical stimulation (TENS) therapy, pulse electrical stimulation therapy, interferential electricity, magnetic therapy, wax therapy, etc.). Psychotherapy includes stress reduction and cognitive behavioral therapy. In addition, alternative therapies such as acupuncture should not be ignored. These measures should be combined with medication to maximize pain relief. Intrathecal slow-release analgesic implantation therapy This method is mostly used for cancer analgesia, but in recent years, it has also been applied to non-cancer chronic analgesia. 3. Surgery: Stimulation and destruction of certain links of pain transmission, or even the pain center, including peripheral nerve stimulation, spinal cord thermocoagulation, spinal cord stimulation, spinal cord and deep brain stimulation, anterolateral spinal cord dissection, spinal cord radiculectomy, spinal nerve entry point disruption, spinal column stimulation, and so on. Stimulation, etc. Among them, TENS, destruction of the posterior root entry zone (DREZ) of spinal nerves (overall effectiveness rate of 70% to 90%), spinal cord stimulation (SCS) and deep brain stimulation are more effective. 4.Spinal cord stimulation Spinal cord stimulation (spinalcordstimulation, SCS) is a therapeutic method by placing the stimulation electrode device into the epidural cavity of the vertebral canal, and then the electric pulse generator generates a continuous current to stimulate the sensory neurons in the posterior horn of the spinal cord and the posterior column conduction bundles, so as to block the conduction of pain signals, thus achieving the therapeutic purpose. A domestic case of brachial plexus nerve injury recurrent pain for 38 years of patients, has repeatedly brachial plexus nerve block, stellate ganglion block and other treatments, but the efficacy of the treatment can not be sustained, for many years through the oral pregabalin, hydrocodone hydrochloride extended-release tablets and other drugs to control the pain, the condition is still recurrent, and there are a variety of adverse reactions to the drug, and ultimately, through the spinal cord electrical stimulation surgical treatment, the pain immediately disappeared after the operation, and achieved immediate results. The effect was immediate. In 1975, Dooley et al. invented the method of using puncture technology to place electrode wires into the epidural cavity and low current stimulation to treat pain, which triggered a boom in the use of spinal cord electrical stimulation to treat pain in Europe and the United States. At that time, due to the limitations of equipment and theory, the therapeutic effect was not very stable. In recent years, with the deepening of understanding and the updating and improvement of equipment, the success rate and efficiency of treatment have been continuously improved. Currently, the SCS system consists of stimulating electrodes, extension wires, electrical pulse generators, and patient and physician programmed control devices. The stimulating electrodes are surgically placed into the epidural space and the extension leads are connected through a subcutaneous tunnel to an electrical pulse generator buried around the abdomen or buttocks. The electrical pulse generator generates a continuous low current to achieve the therapeutic effect. In Japan and the United States, it is now common to use wire or sheet electrodes with multi-electrode contacts that can reach the length of 3 vertebrae. This requires the spine surgeon to place and fix the electrodes in the epidural space of the intended spinal cord segment through a spinal plate opening surgery. Various studies in recent years on SCS for the treatment of postoperative pain after lumbar spine surgery and intractable neuralgia have shown that SCS is effective in about 80% of cases, and Kumar et al. reported that in 100 patients with failed backsurgery syndrome (FBSS), who had predominantly lower-extremity pain, 88% of the patients had significant pain improvement after SCS treatment. In neighboring Japan, there have also been many reports of SCS for the treatment of extremity neuralgia not arising from nerve root or spinal cord compression in recent years. The efficacy is also very obvious. SCS treatment can avoid drug dependence and other side effects caused by long-term use of analgesic drugs in pain patients. Q: What are the contraindications to SCS treatment? A: SCS is contraindicated in patients with the following diseases or symptoms: (1) myocardial infarction within 3 months; (2) severe hypertension or diabetes mellitus; (3) personality disorders or psychologically unstable patients; (4) pregnant patients; (5) implantable cardioverter-defibrillator (ICD) or pacemaker dependence; (6) patients with localized infections in the pre-implantation site; (7) patients with chronic pain in the implantation site; (8) patients with chronic pain in the implantation site; and (9) patients with chronic pain in the implantation site. (6) patients with localized infections at the preimplantation site; (7) patients in whom electrodes cannot be implanted because of severe spinal anatomic mechanism abnormalities; (8) patients on anticoagulant medications; and (9) patients with drug dependence. Q: What is the entire treatment process of spinal cord electrical stimulation? A: The treatment is generally divided into two phases, Phase I surgery (experiential treatment) and Phase II surgery (long-term treatment). 1. Evaluation and Setting Treatment Goals Before receiving treatment, you will need to communicate with your doctor about your goals and expectations. Phase I Surgery A very minimally invasive surgery in which the surgeon places electrodes into the epidural of the spinal cord, allowing you to experience and feel the effects of pain control during the surgery. 3.Experience treatment Back to the hospital room, you can continue to experience the spinal cord electrical stimulation treatment, you can self-adjust the stimulation intensity within the safety range set by the doctor, fully feel and adapt to determine the effect of the treatment. 4.Surgery Embedding the long-term neurostimulator system into the body. 5. Discharge Taking the patient controller home, you can control the symptoms by yourself. However, it is necessary to observe the precautions for self-care in daily life. 6. Regular Follow-up You will need to return to the hospital every six months or once a year for a follow-up visit. Preparation for Experience Therapy Q: What is experience therapy? A: One of the advantages of spinal cord stimulation is that before you decide to have a neurostimulator implanted for a long period of time, you can experience the effects of spinal cord stimulation and try it out to see if it can help you improve your symptoms. To undergo the experimental treatment, you will need to cooperate with your doctor to complete a very minor surgery. Although it needs to be done in an operating room, this is very different from back surgery. The doctor places a temporary electrode on your back in a similar way to a closed loop, and the other end of the electrode is connected to an external temporary system that can be hooked up to your waist and carried around. The temporary stimulator is turned on and it can perform almost the same function as an implanted stimulator. In this way, you can begin to experience the sensation of electrical stimulation of the spinal cord. On the operating table, the surgeon will ask to let you experience which setting feels best, and from there will decide where to leave the electrodes in place. After the procedure, you can return to your hospital room with the temporary system to continue the experience. The experience is a perceptual interaction that can be adjusted outside the body, and you can personally adjust your treatment settings within the safe parameters set by the doctor. When you feel uncomfortable, you can terminate it at any time without causing harm to your body. During the experiential treatment, you will be able to experience and judge for yourself the results, the degree of improvement and whether you are satisfied. You can walk around and do most of the things you are used to doing. However, precautions should be observed to avoid conditions such as displacement of the device or infection. Experienced treatment usually lasts no more than 10 days and no longer than 14 days. Experiencing treatment for too long can lead to an increased risk of infection.