Neurolysis, neurectomy, and nerve repair/reconstruction for chronic pain.

Neuropathic pain may be a result of focal injury to a peripheral nerve. The treatment algorithm begins with nonoperative, then operative, options. In our practice, first-line surgical treatment should directly treat the injured nerve. Nerve decompression or neurolysis is useful in patients with entrapment syndromes and in cases where the course and/or the function of the nerve is altered by local scar or pathoanatomy. Neurectomy is an option in primary cases where numbness is an acceptable alternative to dysesthetic pain, or as an alternative following failed neurolysis. Nerve repair or reconstruction may improve pain by guiding axons past the neuroma.