Surgical Management of Painful Neuromas

Abstract

Chronic pain can be severely disabling and represents a greatly underestimated public health problem. “Pain can kill. It can kill the spirit, vitality and the will to live,” said Joel Saper, MD and president of the American Headache Society, in response to law the US Congress passed into provision in late 2000, declaring the following decade (January 1st 2001 – 2011) as the Decade of Pain Control and Research. A critical goal of the Decade of Pain initiative was to maximize the public and professional understanding of pain and pain management. Approximately 20% of adult Europeans suffer from chronic pain of moderate to severe intensity, seriously affecting the quality of their social and working lives. Neuropathic pain is thought to be a particularly distressing chronic pain condition that is often under-diagnosed and under-treated. Neuropathic pain has been defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system, and is often therapy resistant for reasons largely unknown. Pain intensity and duration are reported to be higher in comparison to chronic pain without neuropathic characteristics. Recently published studies involving epidemiological surveys in Europe suggested neuropathic pain to have a prevalence of 7–8% in the general population. Approximately 3-5% of all patients involved in peripheral nerve injury develop a symptomatic neuroma. In the Netherlands, there are approximately 3.5/100,000 or 580 new cases of neuropathic pain caused by traumatic or iatrogenic nerve injury every year