Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Poppler, Louis H.; Parikh, Rajiv P.; Bichanich, Miles J.; Rebehn, Kelsey; Bettlach, Carrie R.; Mackinnon, Susan E.; Moore, Amy M.
• Is Part Of: Pain. Volume 159:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: Neuroma -- Surgery -- Operation -- Operate -- Reconstruction -- Restoration -- Procedure -- Surgical intervention -- Allodynia -- Burning -- Hyperalgesia -- Extremity -- Peripheral -- Hand -- Arm -- Leg -- Foot -- Neurectomy -- Transposition -- Transpos* -- Excision -- Excis* -- Pain relief -- Pain management -- Outcome -- Analgesia -- Treatment outcome -- Therapy -- Visual analogue scale -- VAS -- Faces pain scale -- Pain scale -- Quality of life -- Health related quality of life -- Dash questionnaire -- Dash score -- Disabilities of the arm shoulder and hand; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000001101
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Abstract: A consensus on the optimal treatment of painful neuromas does not exist. Our objective was to identify available data and to examine the role of surgical technique on outcomes following surgical management of painful neuromas. In accordance with the PRISMA guidelines, we performed a comprehensive literature search to identify studies measuring the efficacy of the surgical treatment of painful neuromas in the extremities (excluding Morton's neuroma and compression neuropathies). Surgical treatments were categorized as excision-only, excision and transposition, excision and cap, excision and repair, or neurolysis and coverage. Data on the proportion of patients with a meaningful reduction in pain were pooled and a random-effects meta-analysis was performed. The effects of confounding, study quality, and publication bias were examined with stratified, meta-regression, and bias analysis. Fifty-four articles met the inclusion criteria, many with multiple treatment groups. Outcomes reporting varied significantly and few studies controlled for confounding. Overall, surgical treatment of neuroma pain was effective in 77% of patients [95% confidence interval: 73-81]. No significant differences were seen between surgical techniques. Among studies with a mean pain duration greater than 24 months, or median number of operations greater than 2 prior to definitive neuroma pain surgery, excision and transposition or neurolysis and coverage were significantly more likely than other operative techniques to result in a meaningful reduction in pain ( P < 0.05). Standardization in the reporting of surgical techniques, outcomes, and confounding factors is needed in future studies to enable providers to make comparisons across disparate techniques in the surgical treatment of neuroma pain. Abstract : Supplemental Digital Content is Available in the Text.