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Journal of Hand Surgery (British and European Volume)
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Articles

The Potential Role of Nerve Growth Factor (NGF) in Painful Neuromas and the Mechanism of Pain Relief by their Relocation to Muscle

D. D. ATHERTON
O. TAHERZADEH
P. FACER
D. ELLIOT
P. ANAND

From the Peripheral Neuropathy Unit, Imperial College School of Medicine, Hammersmith Hospital, London, UK and The Hand Surgery Department, St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK

Correspondence: Professor P. Anand, MA, MD, FRCP, Peripheral Neuropathy Unit, Imperial College London, Area A, Ground Floor, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK. Tel.: + 44 20 8383 3309/3319; fax: + 44 20 8383 3363. E-mail: p.anand{at}imperial.ac.uk

Painful neuromas have been successfully treated by surgical procedures including relocation to muscle, but the underlying molecular mechanism remains unclear. Nerve growth factor (NGF) is secreted by tissues and promotes the expression of ion channels and neuropeptides in sensory neurons involved in pain transmission. We hypothesised that excess of NGF may lead to pain in neuromas and that the efficacy of surgical relocation results from deprivation of NGF, i.e. translocation from NGF-rich regions, particularly sub-cutaneous structures associated with injury or inflammation, to NGF-poor structures such as muscle or bone. Using immunohistological methods with primary antibodies to rhNGF, we report that NGF levels were elevated in 13 painful neuromas in comparison with six control nerves. However, in four painful neuromata re-located into muscle with pain relief, the NGF level was similar to that of controls. NGF levels suggest an explanation for the development of painful neuromas and the efficacy of relocation.

Key Words: NGF • neuroma • neuropathic pain • neuroma relocation

Journal of Hand Surgery (British and European Volume), Vol. 31, No. 6, 652-656 (2006)
DOI: 10.1016/J.JHSB.2006.06.009
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