{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:14:57Z","timestamp":1788783297573,"version":"build-2803163510"},"reference-count":49,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Neuromas can cause severe neuropathic pain, leading to functional decline and psychosocial distress. For pain relief, patients refractory to medications for neuropathic pain may be prescribed opioids; however, such use has been shown to have unfortunate adverse effects. With increasing awareness and diagnostic capabilities for neuroma formation, this study evaluates whether upper extremity neuroma excision may reduce opioid use and if adjunctive nerve procedures further reduce opioid use.<\/jats:p>\n                  <jats:p>The PearlDiver database was queried for patients undergoing upper extremity neuroma excision surgery from 2010 to 2020. Patients with opioid prescription fill records preoperatively were extracted and stratified by an operative technique involving either (1) excision alone, (2) nerve implantation into bone or muscle, or (3) nerve reconstruction. Records were then assessed at 1, 3, and 6 months postoperatively to assess for opioid use. Prescription fill rates at 1, 3, and 6 months postoperatively were then assessed across techniques.<\/jats:p>\n                  <jats:p>Of the 14,330 patients that underwent upper extremity neuroma excision, 4,156 filled opioids preoperatively. Excision led to significant reductions in opioid prescription fill rates postoperatively, decreasing to 67.4% at 1 month and to 57.5% by 6 months (p\u2009&lt;\u20090.001). Excision alone resulted in lower opioid use compared with excision with implantation at all postoperative time points (p\u2009&lt;\u20090.05). At 6 months, opioid use was also significantly less following excision with nerve reconstruction compared with implantation (56.4% vs. 65.6%, p\u2009=\u20090.0096). There were no differences between excision alone and excision with nerve reconstruction.<\/jats:p>\n                  <jats:p>Neuroma excision significantly reduces opioid use in patients with preoperative opioid use while adjunctive operative techniques did not potentiate opioid reduction. This highlights the importance of understanding patient complaints, neuroma localization, and candidacy for excision as an effective measure for addressing opioid use in patients with preoperative opioid dependence.<\/jats:p>","DOI":"10.1055\/a-2576-0128","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T18:59:16Z","timestamp":1744052356000},"page":"124-131","source":"Crossref","is-referenced-by-count":2,"title":["The Efficacy of Upper Extremity Neuroma Surgery in Reducing Long-Term Opioid Use in Patients with Preoperative Opioid Use"],"prefix":"10.1055","volume":"42","author":[{"given":"Emmanuel O.","family":"Emovon III","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Langdell","sequence":"additional","affiliation":[{"name":"Division of Plastic, Oral, and Maxillofacial Surgery, Duke University Medical Center; Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliott","family":"Rebello","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Alex","family":"Albright","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Ong","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Y.","family":"Joh","sequence":"additional","affiliation":[{"name":"Division of Plastic, Oral, and Maxillofacial Surgery, Duke University Medical Center; Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhail K.","family":"Mithani","sequence":"additional","affiliation":[{"name":"Division of Plastic, Oral, and Maxillofacial Surgery, Duke University Medical Center; Durham, North Carolina"},{"name":"Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopedic Surgery, Duke University Medical Center; Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neill Y.","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopedic Surgery, Duke University Medical Center; Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.hcl.2021.05.002","article-title":"Targeted muscle reinnervation for the treatment of neuroma","volume":"37","author":"L E Janes","year":"2021","journal-title":"Hand Clin"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.bjps.2013.06.019","article-title":"The incidence of symptomatic neuroma in amputation and neurorrhaphy patients","volume":"66","author":"D J van der Avoort","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"86.e1","DOI":"10.1016\/j.jhsa.2017.08.021","article-title":"Symptomatic neuroma following initial amputation for traumatic digital amputation","volume":"43","author":"M A Vlot","year":"2018","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s11552-014-9692-0","article-title":"Social impact of peripheral nerve injuries","volume":"10","author":"D M Wojtkiewicz","year":"2015","journal-title":"Hand (N Y)"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/PRS.0000000000003018","article-title":"Surgical treatment of neuromas improves patient-reported pain, depression, and quality of life","volume":"139","author":"L F Domeshek","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.nec.2014.07.002","article-title":"Neurolysis, neurectomy, and nerve repair\/reconstruction for chronic pain","volume":"25","author":"L J Lipinski","year":"2014","journal-title":"Neurosurg Clin N Am"},{"issue":"34","key":"ref7","doi-asserted-by":"crossref","first-page":"57670","DOI":"10.18632\/oncotarget.16917","article-title":"Treatments of traumatic neuropathic pain: a systematic review","volume":"8","author":"C Yao","year":"2017","journal-title":"Oncotarget"},{"issue":"S 01","key":"ref8","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1093\/pm\/pnz075","article-title":"A comprehensive algorithm for management of neuropathic pain","volume":"20","author":"D Bates","year":"2019","journal-title":"Pain Med"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.3171\/2017.1.JNS161778","article-title":"Evaluation of surgical treatment for neuropathic pain from neuroma in patients with injured peripheral nerves","volume":"128","author":"V Decrouy-Duruz","year":"2018","journal-title":"J Neurosurg"},{"issue":"10","key":"ref10","first-page":"CD006380","article-title":"Pharmacologic interventions for treating phantom limb pain","volume":"10","author":"M J Alviar","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/S0304-3959(00)00385-7","article-title":"The effect of opioids on phantom limb pain and cortical reorganization","volume":"90","author":"E Huse","year":"2001","journal-title":"Pain"},{"issue":"25","key":"ref12","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1056\/NEJM200506233522520","article-title":"Morphine, gabapentin, or their combination for neuropathic pain","volume":"352","author":"I Gilron","year":"2005","journal-title":"N Engl J Med"},{"issue":"08","key":"ref13","first-page":"CD006146","article-title":"Opioids for neuropathic pain","volume":"2013","author":"E D McNicol","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ejp.1494","article-title":"Opioids for chronic non-cancer neuropathic pain. An updated systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration","volume":"24","author":"C Sommer","year":"2020","journal-title":"Eur J Pain"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.pharmthera.2007.10.003","article-title":"Role of receptor internalization in opioid tolerance and dependence","volume":"117","author":"T Koch","year":"2008","journal-title":"Pharmacol Ther"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.fpc.0000182781.87932.0d","article-title":"Pharmacogenetics of opioid receptors and addiction","volume":"16","author":"P Mayer","year":"2006","journal-title":"Pharmacogenet Genomics"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"483","DOI":"10.4088\/JCP.v68n0320a","article-title":"Gabapentin abuse, and delirium tremens upon gabapentin withdrawal","volume":"68","author":"C Pittenger","year":"2007","journal-title":"J Clin Psychiatry"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1177\/1060028015620800","article-title":"Gabapentin: abuse, dependence, and withdrawal","volume":"50","author":"T L Mersfelder","year":"2016","journal-title":"Ann Pharmacother"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"841","DOI":"10.2106\/00004623-195133040-00003","article-title":"Methods of treatment of neuromata of the hand","volume":"33-A","author":"G H Grant","year":"1951","journal-title":"J Bone Joint Surg Am"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"S247","DOI":"10.1097\/SAP.0000000000001851","article-title":"A systematic review of sensory outcomes of digital nerve gap reconstruction with autograft, allograft, and conduit","volume":"82","author":"J T Mauch","year":"2019","journal-title":"Ann Plast Surg"},{"issue":"10","key":"ref21","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.2106\/JBJS.18.00417","article-title":"No difference in outcomes detected between decellular nerve allograft and cable autograft in rat sciatic nerve defects","volume":"101","author":"P Tang","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s11552-008-9158-3","article-title":"Limitations of conduits in peripheral nerve repairs","volume":"4","author":"A M Moore","year":"2009","journal-title":"Hand (N Y)"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1097\/01.prs.0000299281.57480.77","article-title":"The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps","volume":"121","author":"I Ducic","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref24","doi-asserted-by":"crossref","first-page":"e1952","DOI":"10.1097\/GOX.0000000000001952","article-title":"Surgical algorithm for neuroma management: a changing treatment paradigm","volume":"6","author":"K R Eberlin","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/j.pain.0000000000001101","article-title":"Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis","volume":"159","author":"L H Poppler","year":"2018","journal-title":"Pain"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.jhsg.2024.01.018","article-title":"The role of nerve tension on nerve repair success","volume":"6","author":"T J McQuillan","year":"2024","journal-title":"J Hand Surg Glob Online"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/S0736-0266(01)00104-8","article-title":"An in vivo study of peripheral nerves in continuity: biomechanical and physiological responses to elongation","volume":"20","author":"P J Driscoll","year":"2002","journal-title":"J Orthop Res"},{"issue":"06","key":"ref28","doi-asserted-by":"crossref","first-page":"661","DOI":"10.4103\/1673-5374.130094","article-title":"Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries","volume":"9","author":"B He","year":"2014","journal-title":"Neural Regen Res"},{"issue":"12","key":"ref29","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.jhsa.2020.07.016","article-title":"A multicenter matched cohort study of processed nerve allograft and conduit in digital nerve reconstruction","volume":"45","author":"F J Leversedge","year":"2020","journal-title":"J Hand Surg Am"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"S350","DOI":"10.1097\/SAP.0000000000003342","article-title":"Traditional neuroma management strategies: a systematic review","volume":"90","author":"J Chou","year":"2023","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.hcl.2015.08.006","article-title":"Pain examination and diagnosis","volume":"32","author":"C Curtin","year":"2016","journal-title":"Hand Clin"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.pmn.2004.10.004","article-title":"Neuropathic pain: a guide to comprehensive assessment","volume":"5","author":"K Herr","year":"2004","journal-title":"Pain Manag Nurs"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0039-6109(05)70381-9","article-title":"Measurement of pain","volume":"79","author":"J Katz","year":"1999","journal-title":"Surg Clin North Am"},{"issue":"02","key":"ref34","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1055\/s-0041-1731640","article-title":"Long-term opioid use following surgery for symptomatic neuroma","volume":"38","author":"J Lans","year":"2022","journal-title":"J Reconstr Microsurg"},{"issue":"11","key":"ref35","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.jhsa.2022.06.026","article-title":"Preoperative patient-reported data indicate the risk of prolonged opioid use after hand and upper extremity surgeries","volume":"47","author":"M M Shipp","year":"2022","journal-title":"J Hand Surg Am"},{"issue":"07","key":"ref36","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1016\/j.arthro.2020.03.008","article-title":"Risk factors for postoperative opioid use in arthroscopic shoulder labral surgery","volume":"36","author":"T R Jildeh","year":"2020","journal-title":"Arthroscopy"},{"issue":"02","key":"ref37","doi-asserted-by":"crossref","first-page":"358e","DOI":"10.1097\/PRS.0000000000010297","article-title":"Patient-reported data augment health record data for prediction models of persistent opioid use after elective upper extremity surgery","volume":"152","author":"A M Giladi","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref38","doi-asserted-by":"crossref","first-page":"e3789","DOI":"10.1097\/GOX.0000000000003789","article-title":"Impact of nerve surgery on opioid and medication use in patients with chronic nerve injuries","volume":"9","author":"J M Felder","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"02","key":"ref39","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/SLA.0000000000003088","article-title":"Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: a randomized clinical trial","volume":"270","author":"G A Dumanian","year":"2019","journal-title":"Ann Surg"},{"issue":"10","key":"ref40","doi-asserted-by":"crossref","first-page":"2984","DOI":"10.1007\/s11999-014-3528-7","article-title":"Targeted muscle reinnervation: a novel approach to postamputation neuroma pain","volume":"472","author":"J M Souza","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"ref41","doi-asserted-by":"crossref","first-page":"e3832","DOI":"10.1097\/GOX.0000000000003832","article-title":"Clinical outcomes of symptomatic neuroma resection and reconstruction with processed nerve allograft","volume":"9","author":"S A Jain","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"03","key":"ref42","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1053\/j.jfas.2017.11.022","article-title":"Superficial peroneal nerve to deep peroneal nerve transfer with allograft conduit for neuroma in continuity","volume":"57","author":"C Bibbo","year":"2018","journal-title":"J Foot Ankle Surg"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1053\/j.jfas.2016.09.005","article-title":"Nerve transfer with entubulated nerve allograft transfers to treat recalcitrant lower extremity neuromas","volume":"56","author":"C Bibbo","year":"2017","journal-title":"J Foot Ankle Surg"},{"issue":"03","key":"ref44","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1055\/s-0042-1755262","article-title":"The current state of targeted muscle reinnervation: a systematic review","volume":"39","author":"A R Walsh","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"08","key":"ref45","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1055\/a-2273-3940","article-title":"Economic cost-benefit analysis of nerve implanted into muscle versus targeted muscle reinnervation versus regenerative peripheral nerve interface, for treatment of the painful neuroma","volume":"40","author":"Z Zamore","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"08","key":"ref46","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1016\/j.bjps.2020.01.034","article-title":"Surgery for lower extremity symptomatic neuroma: long-term outcomes","volume":"73","author":"N Anantavorasakul","year":"2020","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref47","doi-asserted-by":"crossref","first-page":"563e","DOI":"10.1097\/PRS.0000000000006552","article-title":"Patient-reported outcomes following surgical treatment of symptomatic digital neuromas","volume":"145","author":"J Lans","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"08","key":"ref48","doi-asserted-by":"crossref","first-page":"e0287697","DOI":"10.1371\/journal.pone.0287697","article-title":"Postoperative opioid prescribing patients with diabetes: opportunities for personalized pain management","volume":"18","author":"A Zammit","year":"2023","journal-title":"PLoS One"},{"issue":"02","key":"ref49","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/PRS.0000000000009334","article-title":"Factors related to neuropathic pain following lower extremity amputation","volume":"150","author":"J Lans","year":"2022","journal-title":"Plast Reconstr Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2576-0128.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:40:21Z","timestamp":1769730021000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2576-0128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,7]]},"references-count":49,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,1,29]]},"published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2576-0128","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4,7]]},"published":{"date-parts":[[2025,4,7]]}}}