Treatment of Painful Neuromas

Neuropathic pain is pain that results from disturbances in the nervous system. This kind of pain can progress to the point that it is chronic and unremitting. Quite often, this kind of pain is caused by the development, from nerve fiber tissue, of a mass of scar tissue at the end of a damaged nerve, a condition called a neuroma. The condition can require microsurgical intervention for removal of the neuroma and treatment and repair of the affected nerve.

Prof. Shimon Rochkind, a senior neurosurgeon at the Neurosurgical Center for Excellence at the Herzliya Medical Center is an expert at performing these operations.

What is a Neuroma?

A neuroma is a benign tumor (that is, non-malignant) that develops from nerve tissue. Neuromas tend to develop following injury to a nerve and can therefore appear in different areas of the body. Any nerve trauma – laceration, stabbing, gunshot, etc. – anything that causes the nerve to be either partially or completely severed can stimulate the growth of a neuroma adjacent to the area of the injury.

There are a number of different types of neuromas, including:

  • Morton’s Neuroma: In this case, the mass of scar tissue presses on a main nerve in the foot causing chronic pain in the toes.
  • Amputation Neuroma: A kind of neuroma that develops at the location where a limb was amputated.
  • Traumatic Neuroma: Can form as a result of damage to a nerve caused by an accident, direct damage to the nerve or occasionally following surgical intervention.

The development of a neuroma can have many implications: its very growth on the nerve can lead to the exertion of pressure on it and disrupt the nerve’s ability to transmit electrical signals – an ability that was likely already damaged by the original external injury that caused the development of the neuroma in the first place. This kind of complication often causes severe pain in the area of the injury because of damage to the nerve that can no longer transmit normal electrical signals to the brain and instead sends constant and unabating pain signals despite the absence of a pain-inducing stimulus. This pain can spread and radiate to adjacent structures above and below the area of the nerve damage and the area occupied by the neuroma.

Painful Neuromas – Symptoms

Nerve pain differs from regular pain in that it can appear immediately after an injury but it can also appear much later. It is typically chronic and does not remit without treatment. Following nerve injury, the following symptoms can appear:

  • Burning pain, shocking sensations, stab- or cut-like pain.
  • Numbness or a feeling of “pins and needles” in the area of the injury.
  • Allodynia, which is pain caused by typically non-painful stimuli. Thus, for example, even a light stimulus from wind or clothing can cause the sensation of pain in the affected area.
  • Hyperalgesia, which is when stimuli that typically cause tolerable pain, such as blood draws, cause intolerable pain.
  • Hyperpathia, which is an exaggerated or excessive pain response to painful stimuli that does not remit when the stimulus is removed. Central pain can be worsened by external stimuli such as changes in the weather, contact with clothing or shoes, etc.

Painful Neuroma – A Condition that Requires Treatment

The development of a neuroma can often cause symptoms so severe that they become intolerable: the chronic and incessant pain appears without any “real” direct reason, though it is so severe that that it disrupts a person’s ability to function normally. This condition is known in medical jargon as a painful neuroma because the pain is caused by the neuroma itself.

Treatment for the condition requires care for nerve itself focused on restoring the nerve’s normal function as much as possible. While a damaged nerve can rarely be restored to full pre-injury function, the neurosurgical and microsurgical treatments that have been developed over the years, which are Prof. Rochkind’s specialty, can provide optimal conditions for reducing the pain and improving quality of life.

Surgery is therefore the recommended treatment for stopping or reducing the pain associated with painful neuromas. In the first stage of the procedure, the surgeon releases the nerve from the scar tissue that has formed around the nerve following the external injury. Release of the nerve is performed by dissecting it from the scar tissue that is pressing on it, completely separating it from this tissue.

After releasing the damaged nerve, the neuroma itself is then removed in order to eliminate local neural irritation, thereby “releasing” the entire area of the nerve to a greater extent. Following its removal, the neuroma is, of course, sent for pathological testing. During the final stage, the proximal end of the nerve (the end that is closest to the center of the body and the central nervous system) is buried in an adjacent muscle. This provides the nerve with fertile “soil” in which to grow, significantly decreasing the risk of re-growth of the neuroma.

The operation lasts roughly two hours due to the delicacy and precision required, and then patient usually remains in the hospital for 24 hours after completion of the procedure. The frequency and intensity of the pain typically decrease relatively quickly, due to the removal of the neuroma and the provision of an environment (muscle) for the growth of the end of the damaged nerve.

The surgical procedure for the treatment of painful neuromas is considered to be particularly delicate and complex and requires the skills and expertise of an experienced surgeon. It is therefore crucial that the correct surgeon be selected to perform the procedure.

Prof. Shimon Rochkind, a world-renowned surgeon with extensive experience in the treatment of conditions in the peripheral nervous system, has performed a large number of operations for the treatment of painful neuromas, with particularly high success rates.  Prof. Rochkind offers consultations to patients at the Neurosurgical Center for Excellence at the Herzliya Medical Center regarding the most appropriate treatment for their condition, and offers microsurgical procedures for the treatment of painful neuromas. Furthermore, in certain cases, Prof. Rochkind performs the surgical treatment in collaboration with the relevant specialist for the injury from which the patient is suffering.

Are you suffering from chronic pain for no apparent reason?

Did chronic pain appear after a traumatic injury?

You may be suffering from a painful neuroma.

Contact us today at the Neurosurgical Center for Excellence and make an appointment.

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