Definition, Etiology, and Epidemiology of Symptomatic Neuroma

Neuroma, the hypersensitive bulbous end of a transected nerve, has been described for centuries but has posed difficulty in treatment both historically and today. Although nerve surgery has benefited from dramatic shifts in innovation, the treatment of symptomatic neuroma continues to be particularly challenging. There are a number of considerations for the practicing surgeon in determining the best treatment options for neuroma. First, neuroma prevention is critical to the success of pain prevention. Second, restoration of the continuity of the nervous system is key to preventing formation of neuroma. Third, neuroma pain must be differentiated from neuropathic pain of other origin. We propose four types of pain that characterize neuropathic pain (neuroma pain, compression pain, collateral sprouting (painful hyperalgesia), and phantom nerve pain (deafferentation pain)), with only two responding to surgical intervention (neuroma pain and compression pain). Finally, for all other neuropathic pain conditions, multidisciplinary pain management is essential.