Insufficient pain relief after surgical neuroma treatment: prognostic factors and central sensitisation
Received 19 January 2009; accepted 18 May 2009. published online 26 June 2009. Corrected Proof
Summary
Background
Treatment of patients with neuromatous pain is difficult. Numerous treatment methods have been described, but none has been completely effective in providing sufficient pain relief. Patient-specific prognostic factors, predicting pain after surgical neuroma treatment, can help clinicians in the process of patient treatment and care.
Methods
A computerised bibliographical database (PubMed Medline) was searched for articles concerning prognostic factors predicting the outcome of surgical neuroma treatment, and all the reference lists were checked.
Results
Evidence for predicting the outcome was found for neuromas of the radial sensory branch and digital nerves, discrete nerve syndrome, workers compensation, employment status, litigation involvement, duration of pain and number of previous operations. Psychosocial problems are often found in neuroma patients. In chronic neuropathic pain patients, changes in the central nervous system at the level of spinal cord and in the somatosensory cortex can be found.
Conclusions
Neuromas of the radial sensory branch and digital nerves, discrete nerve syndrome, workers' compensation, employment status, litigation involvement, duration of pain and number of previous operations appear to predict the amount of pain after neuroma surgery. However, in a minority of patients, a bad outcome cannot be explained by these factors; in these patients, central sensitisation and psychosocial factors may play a role in maintaining pain. Research focussing on prognostic factors and the central changes induced by painful peripheral injury can lead to new and improved clinical treatment algorithms for the relief and prevention of chronic neuropathic pain.
Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Corresponding author. Research Unit, Department of Plastic and Reconstructive Surgery, Room Ee15.91, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Tel.: +31 10 408 7303; fax: +31 10 408 9410.
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ABSTRACT