Surgical Treatment of Neuromas Improves Patient-Reported Pain, Depression, and Quality of Life

Domeshek, Leahthan F.; Krauss, Emily M.; Snyder‐Warwick, Alison K.; Laurido-Soto, Osvaldo; Hasak, Jessica M.; Skolnick, Gary B.; Novak, Christine B.; Moore, Amy M.; Mackinnon, Susan E.

doi:10.1097/prs.0000000000003018

Cited by 70 publications

(66 citation statements)

References 51 publications

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“…However, transposition or coverage with a flap to move the neuroma away from the skin was significantly better in patients who had 2 or more prior neuroma operations, or who had pain lasting longer than 2 years [5]. Our own clinical experience with neuroma crush and deep transposition shows improvement in most patients [7,49,96].…”

Section: Peri-operative Carementioning

confidence: 91%

“…In general, the more adjectives used, the more serious their pain response. Following surgery, the number of adjectives reported decreases [49]. Typically, pain from compression neuropathy is not as painful as that from neurotomy and surgery to treat a compression neuropathy is reliably successful.…”

Section: Historymentioning

confidence: 99%

“…In this case, you will see the trigger point or point of maximum pain marked by the patient retract. Prior to making any cut to the nerve, we crush the nerve as proximally as possible within the operative field, creating an axonotmetic injury (Sunderland II), to set the point front of regeneration far away from the cut nerve end [49]. Our clinical experience in patients with neuropathic pain suggests that neurotmetic injury (Sunderland IV, V, or Mackinnon VI) is much more painful than an axonotmetic injury.…”

Section: Peri-operative Carementioning

confidence: 99%

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The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler

Mackinnon

2019

Neurotherapeutics

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Pain is a frequent cause of physician visits. Many physicians find these patients challenging because they often have complicated histories, emotional comorbidities, confusing examinations, difficult problems to fix, and the possibility of factitious complaints for attention or narcotic pain medications. As a result, many patients are lumped into the category of chronic, centralized pain and relegated to pain management. However, recent literature suggests that surgical management of carefully diagnosed generators of pain can greatly reduce patients' pain and narcotic requirements. This article reviews recent literature on surgical management of pain and four specific sources of chronic pain amenable to surgical treatment: painful neuroma, nerve compression, myofascial/ musculoskeletal pain, and complex regional pain syndrome type II.

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Section: Peri-operative Carementioning

confidence: 91%

Section: Historymentioning

confidence: 99%

Section: Peri-operative Carementioning

confidence: 99%

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The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler

Mackinnon

2019

Neurotherapeutics

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“…It is estimated that 1‐3% of all upper extremity trauma patients are diagnosed with nerve injuries during the first few months after trauma . These injuries are often severely debilitating, resulting in lifestyle disruptions from loss of function, both at work and in leisure . Moreover, traumatic nerve injuries frequently affect relatively young individuals, resulting in lifelong reductions in quality of life and income …”

Section: Introductionmentioning

confidence: 99%

Advances in the repair of segmental nerve injuries and trends in reconstruction

2020

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Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system. K E Y W O R D S acellular nerve allograft, autograft, nerve gap, nerve guidance conduit, peripheral nerve 2 | BIOLOGY OF NERVE REGENERATION ACROSS A DEFECT Peripheral nerve is capable of robust regeneration following injury. The molecular and cellular mechanisms have primarily been studied in rodent models. Following injury, neurons and their axons and the nonneuronal cellular environment distal to the injury undergo immediate morphological and molecular changes. Within the axon, there is a rapid influx of ions, principally calcium, as well as a disruption of transport proteins signaling a disruption to homeostasis with its end-organ. This multifactorial injury response from axon damage is rapidly transported to the neuron cell Abbreviations: ANA, acellular nerve allograft; ECM, extracellular matrix; FDA, Food and Drug Administration; FK506, tacrolimus; GDNF, glial cell line-derived neurotrophic factor; GFRα1, glial cell line-derived neurotrophic factor family receptor alpha-1; MRC, Medical Research

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“…Unfortunately, they are still notoriously difficult to treat. [1][2][3][4][5] Neuromas often occur in the extremities following trauma, but iatrogenic pain in the head and neck area has also been described. Trauma to the occipital nerves and the greater auricular nerve during excision of scalp masses, neurotological procedures, and parotid gland surgery can lead to sensory complications.…”

Section: Introductionmentioning

confidence: 99%

Neurocap Use for the Treatment of Iatrogenic Neuropathic Pain: Preliminary Operative Results in 3 Patients

Thomeer

Tijink

et al. 2020

Ear Nose Throat J

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Painful neuromas are a devastating condition that is notoriously difficult to treat. The large number of techniques that have been attempted suggest that no one technique is superior. Neuromas often occur in the extremities, but iatrogenically caused pain in the head and neck area has also been described. This article describes 3 consecutive patients diagnosed with traumatic neuroma who underwent transection of the causative nerve, followed by capping of the nerve stump with a Neurocap. With a follow-up of 7 to 24 months, our results show a marked reduction in the pain scores of all 3 patients. The preliminary results indicate that this technique might be a viable treatment option for patients with a suspected neuroma in the head and neck area.

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Surgical Treatment of Neuromas Improves Patient-Reported Pain, Depression, and Quality of Life

Abstract: Therapeutic, IV.

Cited by 70 publications

References 51 publications

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Advances in the repair of segmental nerve injuries and trends in reconstruction

Neurocap Use for the Treatment of Iatrogenic Neuropathic Pain: Preliminary Operative Results in 3 Patients

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