Neuromas and postamputation pain

Abstract

Postamputation stump and phantom pain are highly prevalent but remain a difficult condition to treat. The underlying mechanisms are not fully clarified, but growing evidence suggests that changes in afferent nerves, including the formation of neuromas, play an important role. The main objective of this cross-sectional study was to investigate whether ultrasound-verified neuroma swellings are more frequent in amputees with postamputation pain than in amputees without pain (primary outcome). Sixty-seven amputees were included. Baseline characteristics including the frequency and intensity of spontaneous stump and phantom pain were obtained, and sensory characteristics and evoked responses were assessed. A high-frequency ultrasound examination of the amputated extremity was performed to obtain information on the presence, size, and elasticity of swollen neuromas and pressure pain thresholds. Swollen neuromas were present in 53 (79.1%) of the 67 amputees included in the study, in 47 (82.5%) of 57 amputees with pain and in 6 (60.0%) of 10 amputees without pain (P = 0.2). No difference was found in stump pain intensity (P = 0.42) during the last week or in phantom pain intensity in the last month (P = 0.74) between amputees with and without swollen neuromas. Our findings suggest that it is not the presence of swollen neuromas itself that drives postamputation pain. However, changes in the transected nerve endings may still be crucial for driving postamputation pain because a positive Tinel sign was significantly more frequent in amputees with pain, irrespectively of the degree of neuroma swelling.

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

“…13 Furthermore, the amputation level and presence of a neuroma seem to affect the eventual diameters of the nerves. 18 In our study, the prevalence of swollen neuromas was high, which is consistent with that in a study by Nina Stockfleth Buch et al, 19 who reported that 79.1% of amputees had one or more neuromas. Furthermore, the proportion of neuromas in amputees with pain was as high as 81.2%.…”

The Phantom Satiation Hypothesis of Bariatric Surgery

“…Nonetheless, I could invoke the same combination of peripheral and central adaptations described in the case of phantom limbs (Figure 1). The neuroma theory postulates that the disorganized growth of damaged nerve terminals at the site of injury can cause phantom sensations including, but not limited to, unexplained pain (Buch et al, 2020). Our group previously reported the presence of dystrophic and damaged vagal terminals in the stomach of the bypassed mouse (Gautron et al, 2013).…”

Covering the proximal nerve stump with chondroitin sulfate proteoglycans prevents traumatic painful neuroma formation by blocking axon regeneration after neurotomy in Sprague Dawley rats

“…Traumatic neuroma caused by nerve injuries or amputation is an important source of neuropathic pain. 3,20 Although the exact mechanisms by which traumatic neuromas cause pain-related symptoms are still unknown, various methods are used to stop traumatic painful neuroma formation. Generally, surgeons perform direct neuroma excision and then suture the nerve stump to the nearby muscle or vein, and this approach is currently the most commonly used strategy to prevent traumatic neuroma formation in the clinic, which can achieve satisfactory results.…”