Painful Neuromas

Rajput, Kanishka; Reddy, Sapna; Shankar, Hariharan

doi:10.1097/ajp.0b013e31823d30a2

Cited by 76 publications

(66 citation statements)

References 88 publications

(98 reference statements)

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“…After the period of degeneration, neurotrophic factors produced nearby (distal nerve stump, target organs, inflammatory cells, etc.) diffuse and attract regenerated nerve fibers from all directions [43], resulting in a bulb-shaped neuroma comprised of improperly and irregularly distributed nerve fibers intermingled closely with proliferated connective tissue, which additionally disperses the regenerated nerve fibers [44], [45]. This phenomenon was also noted in the proximal stump of the no-capping group in the present study.…”

Section: Discussionsupporting

confidence: 71%

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

et al. 2014

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Nerve capping techniques have been introduced as a promising treatment modality for the treatment of painful neuroma with varied outcomes; however, its exact mechanism is still unknown. RhoA is one of the members of the RAS superfamily of GTPases that operate as molecular switches and plays an important role in peripheral nerve regeneration. Our aim was to investigate the structural and morphologic mechanisms by which the nerve capping technique prevents the formation of painful neuromas after neuroectomy. We also hoped to provide a theoretical basis for this treatment approach. An aligned nanofiber conduit was used for the capping procedure and the sciatic nerve of Sprague-Dawley rats was selected as the animal model. Behavioral analysis, extent of neuroma formation, histological assessment, expressions of pain markers of substance P and c-fos, molecular biological changes as well as ultrastructural features were investigated and compared with the findings in a no-capping control group. The formation of traumatic neuromas was significantly inhibited in the capping group with relatively “normal” structural and morphological features and no occurrence of autotomy and significantly lower expression of pain markers compared to the no-capping group. The gene expression of RhoA was consistently in a higher level in the capping group within 8 weeks after surgery. This study shows that capping technique will alter the regeneration state of transected nerves and reduce painful neuroma formation, indicating a promising approach for the treatment of painful neuroma. The initiation of the “regenerative brake” induced by structural as well as morphological improvements in the severed nerve is theorized to be most likely a key mechanism for the capping technique in the prevention of painful neuroma formation.

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Section: Discussionsupporting

confidence: 71%

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

et al. 2014

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“…Plasticity and “windup” related to peripheral nerve scar tissue traction, compression of residual nerves, ischemia, or peripheral upregulation of ectopic ion channels contributes to unpleasant sensations that localize to the deafferented body part (31). The microenvironment around a peripheral axotomy induces biochemical changes that result in increased expression of voltage-sensitive sodium channels, decreased potassium channel expression, altered transduction molecules involved in mechanosensitivity and heat and cold sensitivity, increased concentrations of inflammatory mediators, and altered adrenoreceptor subtype expression—the end product of which are ectopic action potentials (21,29,32–34).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Image-Guided Cryoablation for the Treatment of Phantom Limb Pain in Amputees: A Pilot Study

Prologo

Gilliland

Miller

et al. 2017

Journal of Vascular and Interventional Radiology

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Purpose To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial. Materials and Methods From January 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure. Results Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001). Conclusions Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.

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“…Herskin et al [25] confirmed that tail docking does cause an increased prevalence of neuroma formation, and that the bigger the docked part of the tail is, the higher the prevalence of neuroma formation. Neuromas are known to increase the risk for spontaneous pain and hypersensitivity [26] and thus may indicate prolonged pain experience due to tail docking, as well as an increased pain perception if the tail is later on bitten.…”

Section: Reviewmentioning

confidence: 99%

Save the pig tail

Valros

Heinonen

2015

Porc Health Manag

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Tail biting is a common problem in modern pig production and has a negative impact on both animal welfare and economic result of the farm. Tail biting risk is increased by management and housing practices that fail to meet the basic needs of pigs. Tail docking is commonly used to reduce the risk of tail biting, but tail docking in itself is a welfare problem, as it causes pain to the pigs, and facilitates suboptimal production methods from a welfare point-of-view. When evaluating the cost and benefit of tail docking, it is important to consider negative impacts of both tail docking and tail biting. It is also essential to realize that even though 100% of the pigs are normally docked, only a minority will end up bitten, even in the worst case. In addition, data suggests that tail biting can be managed to an acceptable level even without tail docking, by correcting the production system to better meet the basic needs of the pigs.

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Painful Neuromas

Cited by 76 publications

References 88 publications

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

Percutaneous Image-Guided Cryoablation for the Treatment of Phantom Limb Pain in Amputees: A Pilot Study

Save the pig tail

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