The peripheral nervous system is defined as the nerves outside the spinal canal. When nerves are injured, cut, or pinched, unfortunately the brain interprets that as pain. Carpal tunnel is one example of a pinching of a peripheral nerve. Neuromas are the result of injury to a specific nerve. The nerve tries to heal, but is frustrated in its attempt by scar tissue. For amputees, the loss of the limb makes it IMPOSSIBLE for the nerve to heal itself. Like a live electrical wire, the free nerve ending can cause severe pain in some patients. In amputees, the loss of connectedness of the end of the nerve can cause unpleasant phantom limb pain.
For too many years, physicians have only given pills for pain. The opioid crisis, in part, has been a result of this mindset.
In a recent clinical trial where the patients were blinded to their surgical treatment, Dr. Dumanian compared the results of standard nerve treatment of hiding the neuroma with a newer procedure called Targeted Muscle Reinnervation, or TMR. TMR gives the injured nerve “somewhere to go and something to do”. He showed that fixing the nerve gives much better outcomes than hiding the injured nerve, with improvements in both local pain and phantoms. Unfortunately, “standard” nerve treatment of trying to hide the nerve didn’t show any improvement for patients.
The following paragraphs are certain specific reasons for painful peripheral nerves. Nerves within the spine and spinal canal are treated by orthopedic surgeons and neurosurgeons, and are not treated by Dr. Dumanian. You may need for than one type of physician to evaluate your nerve problem.
Painful Foot Nerves
It is not uncommon for patients to have injured nerves around the foot and ankle. The nerves can be compressed around the ankle, and the condition of Tarsal Tunnel is very much like the more common carpal tunnel syndrome, causing pain and foot numbness. Nerves can be injured during surgery when foot and ankle surgeons approach the bones of the foot. Finally, even some severe ankle twists can injure nerves. Dr. Dumanian treats painful nerves of the feet by trying to reconstruct the nerve with a nerve graft, or else TMR when it is not possible. See Dr. Dumanian’s paper on the treatment of painful foot nerves.
Painful Abdominal Wall Nerves
There are numerous nerves that serve the abdominal wall. Unfortunately, they can be injured after common surgery approaches to the intestines, including after laparoscopy, incisional hernia repairs, or other incisions. Dr. Dumanian recently wrote a review of his treatment of painful abdominal wall nerves with reconstructions using nerve grafts. When a reconstruction is not possible, Dr. Dumanian uses TMR to give the nerves “somewhere to go and something to do” to help treat pain.
Amputees and Targeted Muscle Reinnervation (TMR)
Phantom Limb Pain in Amputees
Nerve Tumors
Tumors can form on nerves, just as they can involve other types of tissue in the body. The most common type of nerve tumor is the “Schwannoma” or “neurolemmoma”. These tumors feel like small marbles under the skin, and tapping them causes pins, needles, or “shooters” to go down the limb in the distribution of that nerve. They tend to be straightforward to remove, and their removal does not tend to cause any nerve injury, as they push normal nerve out of the way as they grow. They should be removed in the operating room.
Neurofibromas are nerve tumors that can infiltrate the nerve. Removal of a neurofibroma, in contradistinction to the schwannoma, can result in partial or total loss of the function of the nerve. Some patients can have numerous neurofibromas, and that syndrome is called von Recklinghausen’s disease. Rarely, a neurofibroma can become painful at rest—in these situations the neurofibroma can be degenerating into a cancer, and it must be removed.
Speak with your doctor about the evaluation of your nerve tumor, if an MRI should be done, and what are the chances for a loss of function from removal of the tumor.
Pain After Groin Hernia Repair
One patient out of 20 will experience chronic groin pain after the treatment of an inguinal hernia. Dr. Dumanian performs neuroma excision and targeted muscle reinnervation procedure to treat chronic localized pain after inguinal hernia repair. In the office, Dr. Dumanian will often inject local anesthesia to numb the area as a test to see if you are a good candidate for surgery.
Nerve articles by Dr. Dumanian
More about Dr. Dumanian
Dr. Dumanian is a surgical innovator and the first to perform targeted muscle reinnervation. He also is the developer of Mesh Suture. The open mesh design distributes forces to prevent the suture from tearing through tissues in abdominal wall surgery and orthopedics. Dr. Dumanian is also recognized for his work in rectus diastasis / abdominal hernia surgery. To learn more, or to schedule a consultation, contact Dr. Dumanian at 312-695-6022.