Incidence and associations of painful neuroma in a contemporary cohort of lower‐limb amputees

Penna, Anthony N.; Konstantatos, Alex; Cranwell, William; Paul, Eldho; Bruscino-Raiola, Frank

doi:10.1111/ans.14293

Cited by 35 publications

(39 citation statements)

References 27 publications

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“…The stimulation of these two neuromas could reproduce all the subject's symptoms. A cohort study showed that the presence of PLP at a follow-up is significantly associated with the formation of a painful neuroma, 22 which is in line with our observations. There are few random controlled trials that can be used to guide physicians in selecting the optimal treatment for PAP.…”

supporting

confidence: 91%

<p>Ultrasonography-Guided Radiofrequency Ablation for Painful Stump Neuromas to Relieve Postamputation Pain: A Pilot Study</p>

Han

et al. 2020

JPR

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Objective Postamputation pain (PAP) is a serious problem, and thus far, there is no perfect treatment strategy. Clinically, minimally invasive treatments for peripheral neuromas are simple and feasible. This study aimed to investigate the immediate and long-term effects of ultrasonography-guided radiofrequency ablation (RFA) on PAP. Methods Eighteen PAP subjects with painful peripheral neuromas were treated with ultrasonography-guided RFA. Results A total of 18 PAP subjects were included in the final analyses. Fourteen of the 17 subjects with residual limb pain (RLP) (82.4%) had successful outcomes. A successful outcome was noted in 9 of the 13 subjects with phantom limb pain (PLP) (69.2%). There were no significant associations between symptom relief and sex, age, or the duration of symptoms. There were no severe complications. Conclusions Ultrasonography-guided RFA for painful stump neuromas can effectively relieve stump pain and PLP in amputees with PAP (follow-up time was 12 months). Ultrasonography-guided RFA is easy and safe and does not involve radiation exposure, making it very suitable for clinical applications.

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supporting

confidence: 91%

<p>Ultrasonography-Guided Radiofrequency Ablation for Painful Stump Neuromas to Relieve Postamputation Pain: A Pilot Study</p>

Han

et al. 2020

JPR

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“…1,11 Depending upon the level of amputation, the transected nerves typically have large axonal diameters with mixed sensory and motor fascicles. Symptomatic neuroma has primarily been investigated in the trauma population, with rates of 4 to 48% 19 and with a rate varying based on mechanism -a Turkish study of military personnel showed land-mine injuries having significantly higher rates of neuroma than other trauma necessitating amputations. 20 A subset of neuromatous pain is phantom limb pain or pain perceived in a region of the body that is no longer there.…”

Section: Neuromatous Painmentioning

confidence: 99%

“…Pharmacological treatments have included pain relievers such as nonsteroidal anti-inflammatory medications, opioids, serotonin reuptake inhibitors, tricyclic antidepressants, botulinum, anticonvulsants, NMDA (N-methyl D-aspartate) receptor antagonists, β-blockers, calcium channel blockers, and local anesthetic nerve blocks. 19,21 A recent Cochrane review showed that though some medications showed analgesics effects (morphine, ketamine, dextromethorphan, gabapentin), many had significant side effects, and most studies were limited by small sample sizes and/or bias. 25 Psychological treatments have included mirror therapy, biofeedback, relaxation techniques, and hypnosis.…”

Section: Treatment Of Chronic and Phantom Painmentioning

confidence: 99%

Targeted Muscle Reinnervation: Outcomes in Treating Chronic Pain Secondary to Extremity Amputation and Phantom Limb Syndrome

McNamara

Iorio

2019

J Reconstr Microsurg

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Background Secondary to vascular disease, oncological resection, or devastating trauma, lower extremity amputations are performed globally at a yearly rate exceeding 1 million patients. Three-quarters of these patients will develop chronic pain or phantom pain, which presents a functional limitation for prosthetic use and contributes to deconditioning and increased mortality. Targeted muscle reinnervation (TMR) presents a surgical solution to this problem as either a primary or secondary intervention. Methods A review of the existing literature was conducted using a combination of the terms “phantom pain” “chronic pain,” “neuroma,” and “targeted muscle reinnervation” in Medline and PubMed. Results Five articles were found which addressed TMR for pain syndromes, four of which involved lower extremity amputation. Four of the articles were retrospective reviews, and one was a randomized control trial. A total of 149 patients were included, of which 82 underwent lower extremity amputation. Ninety-two of the patients underwent prophylactic TMR, of which 57 were secondary procedures.In patients who underwent TMR at the time of amputation, all studies reported a minimal development of symptomatic neuromas (27%). For secondary TMR, near-complete resolution of previous pain was found (90%). Phantom pain was noted to be similar to other studies in the literature but noted to improve over time with both primary (average drop of 3.5 out of 10 points on the numerical rating scale) and secondary (diminishing from 72% of patients to 13% over 6 months) operations. Conclusion Although much of the current literature is limited to retrospective studies with few patients, these data point toward near-complete resolution of neuroma pain after treatment as well as complete prevention of chronic pain if TMR is used as a prophylactic measure during the index amputation. This study was a level of evidence IV.

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“…In the current analysis, reasons for amputations (traumatic vs nontraumatic) were not associated with incidence estimates in the meta-regression model. It was hypothesized that traumatic amputees recover faster, use prosthesis more, 23 and were, therefore, more likely to detect neuroma pain in the residual limb, 10,22 whereas amputees due to vascular issues were older, with comorbidities, less active, and less likely to complain about issues related to a painful neuroma 10 . The null association between reasons of amputation and incidence of symptomatic neuroma observed in our study is consistent with the findings of a retrospective cohort study, where the incidence of symptomatic neuroma was comparable between traumatic amputees (2/32) and nontraumatic amputees (2/64) ( P = 0.59) 10 …”

Section: Discussionmentioning

confidence: 99%

“…Published incidence of symptomatic neuromata varies widely, with 4% to 49% after lower-limb amputations, 10,11 25% to 26% after upper-limb amputations, 12,13 and 7%% to 8% after finger amputations 14,15 . Studies of incidence of symptomatic neuromata have been limited by small sample sizes and difficulties with the diagnosis because clinical findings are often nonspecific.…”

mentioning

confidence: 99%

A Systematic Review and Meta-analysis on the Incidence of Patients With Lower-Limb Amputations Who Developed Symptomatic Neuromata in the Residual Limb

Huang

Assi²,

Drolet

et al. 2021

Ann Plast Surg

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BackgroundNeuromata developed after major extremity amputation can cause pain, limit the use of prosthetics, and negatively affect the quality of life. The frequency of postamputation neuroma varies widely. The objective of this study was to determine the incidence of patients who developed symptomatic neuromata after lower-limb amputation through a systematic review and meta-analysis.MethodsA systematic review of the literature was performed on 4 major databases. Studies that reported the incidence of symptomatic neuroma in lower-limb amputees were included. A meta-analysis was performed to calculate the pooled incidence of neuromata.ResultsThirteen studies consisting of 1329 patients were included in this meta-analysis. The reported incidence of patients who developed symptomatic neuromata ranged between 4% and 49%. The median duration of follow-up was 8.6 years (interquartile range, 2.0–17.4 years). The pooled percentage (95% confidence interval [CI]) of lower-limb amputees who developed symptomatic neuromata was 19% (12%–29%). In studies with a duration of follow-up at least 3 years, the pooled percentage (95% CI) of lower-limb amputees who developed symptomatic neuromata was 30% (22%–40%). In studies with a follow-up period of fewer than 3 years, the pooled percentage (95% CI) of neuroma incidence was 3% (2%–6%).ConclusionsIn summary, the overall incidence of patients who developed symptomatic neuromata was 19% or approximately 1 in 5 lower-limb amputees. Symptomatic neuromata are more commonly diagnosed when the follow-up period is longer than 3 years. These findings suggest that neuroma after amputation might be underestimated in studies with a short duration of follow-up.

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Incidence and associations of painful neuroma in a contemporary cohort of lower‐limb amputees

Abstract: This study presents a lower incidence of painful post-amputation neuroma to those published in the literature. This may be attributed to improved methodology. The described associations require further investigation into central factors leading to neuroma sensitization.

Cited by 35 publications

References 27 publications

<p>Ultrasonography-Guided Radiofrequency Ablation for Painful Stump Neuromas to Relieve Postamputation Pain: A Pilot Study</p>

<p>Ultrasonography-Guided Radiofrequency Ablation for Painful Stump Neuromas to Relieve Postamputation Pain: A Pilot Study</p>

Targeted Muscle Reinnervation: Outcomes in Treating Chronic Pain Secondary to Extremity Amputation and Phantom Limb Syndrome

A Systematic Review and Meta-analysis on the Incidence of Patients With Lower-Limb Amputations Who Developed Symptomatic Neuromata in the Residual Limb

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