V. Mačionis
Independent researcher, Vilnius, Lithuania
Summary
Background: Although several specific histochemical features of painful (symptomatic) neuromas have been identified, their pathogenesis remains enigmatic. It has not been explained whether these features are causes or consequences of the sensitization that accompanies painful neuromas. It is also puzzling why painful neuromas tend to recur and do not invariably develop in all severed sensory nerves. Recently, it has been hypothesized that sensitization in neuroma pain is due to occult neural lesions, particularly subsymptomatic compressive neuropathy, proximal to the neuroma. However, many known characteristics of painful neuromas have not been summarized in this context. To fill this gap, a question-driven narrative review of the epidemiological, clinical, and histochemical features of painful neuromas was performed to explore whether etiological correlation with proximal neural lesion (PNL) is possible. Evaluation of the topic: The literature indicates that specific painful neuroma features, such as high recurrence rates, relatively larger size in pure sensory nerves, frequent occurrence in mobile nerves and after severe injuries, unilateral occurrence, and immunohistochemical changes, can be explained by the coexistence of a neural lesion proximal to neuromas. A pathophysiologically silent neuroma may become symptomatic because of a double crush-like injury produced by a combination of fibrous compression of the sprouting axons within the neuroma and sensitizing neuroinflammatory effects of an extraneuronal lesion of the same neural axis. Conclusion: The interpretative literature analysis supports the notion that PNL-focused clinical diagnostics and pathogenesis research of the painful neuroma could provide a breakthrough in understanding and treating this disabling condition.
Key words
neuroma – pain – painful neuroma – pathophysiology – review – sensitization
Mačionis V. Painful neuroma pathophysiology review: double crush syndrome due to coexistent proximal neural lesion? Acta Chir Plast 2026; 68 (1–2): 26–33.