A Cohort Study on Neuropathic Pain of the Sural Nerve—Can Neurectomy Be Considered a Valid Treatment Option?

Abstract

BackgroundSural nerve neuroma is often caused by an injury during prior surgery, for example, osteosynthesis or ligament refixations at ankle level. Different surgical techniques to treat neuroma have been described. Neurectomy of an injured symptomatic sural nerve has been described as a treatment option for neuropathic pain. The aim of this study was to evaluate the outcomes of this technique to operatively treat sural nerve neuroma in our department.MethodsFrom 2010 to 2020, a total of 30 consecutive patients with neuropathic pain and suspected neuroma of the sural nerve underwent sural nerve neurectomy. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered.ResultsAfter neurectomy, 22 patients (73.3%) had persisting pain. In logistic regression models evaluating the risk of persisting pain after sural nerve neurectomy, no independent predictor of higher risk of persisting pain could be identified.ConclusionFor sural nerve neuromas, neurectomy remains an option as the surgical morbidity is minor, but patients need to be counseled that only a fourth of those undergoing surgery will be pain-free afterward.

Outcomes of Surgical Treatment for Sural Neuritis: A Retrospective Case Series

“…3-83.3]). Similarly, postoperative VAS scores did not significantly differ between those with (5 [3][4][5][6][7]) vs without (3 [2][3][4]). These were not solely just statistical analyses of only anxiety or only depression because there were fewer than 5 per group with just those diagnoses in isolation.…”

“…Patients who were previously diagnosed with anxiety (with or without depression) demonstrated lower FAAM ADL scores postoperatively (53.6 [34.5-67.9] vs 74.4 [59.5-86.9]) and higher VAS scores (5 [3-7] vs 3 [1][2][3][4]) for those without anxiety, though this did not reach statistical significance in either case. The difference in postoperative FAAM ADL scores for patients with a clinical history of depression (with or without anxiety) did not reach a level of statistical significance in this study (54.8 [34.5-83.3] vs 72.6 [64.…”

“…Having both depression and anxiety preoperatively vs not having these diagnoses was associated with significantly greater pain (VAS 7.0 [3][4][5][6][7][8] 4.…”

“…There were no outcome measures or VAS pain scores reported in that study, and the only outcome was presence or absence of pain following surgery. 4 Another study by Anantavorasakul et al 2 including 32 patients with 48 symptomatic lower extremity neuromas found PROMIS depression scores to be independently associated with inferior PROMIS mobility scores, PROMIS pain interference scores, and higher NRS pain scores. These findings suggest that patients with anxiety and depression may have poorer coping strategies and therefore report inferior results after surgery.…”

“…There were no outcome measures or VAS pain scores reported in that study, and the only outcome was presence or absence of pain following surgery. 4…”