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.