Painful neuroma is a common complication after peripheral nerve injury or amputation, and its intractable pain and high recurrence rate after surgery cause great pain to patients. Since the formation mechanism of painful neuromas is not fully understood, it is reasonable to adopt different treatment methods for painful neuromas in different sites. In this paper, we compare the treatment and efficacy of 33 cases of painful neuromas in the hope of arriving at a better treatment plan. I. General data All 33 patients, 27 males and 6 females, aged 18-68 years, were reoperated after emergency surgery. Nature of injury: except for one case of knife cut injury to the finger nerve, all were post-traumatic amputation patients. There were 16 cases of smash injury, 3 cases of cut injury, 2 cases of electric shock injury, 3 cases of crush injury, 2 cases of car accident, 2 cases of wire strangulation, 1 case of contusion, 1 case of burn injury, and 2 cases of bite injury. There were 1 case of saphenous nerve, 31 finger nerves, 1 case of superficial branch of radial nerve, 2 cases of left shoulder, 2 cases of posterior tibial nerve, and 2 cases of common peroneal nerve. 4 cases showed obvious infection, 3 cases had a medical history of more than 10 years, and the medical history ranged from 1 month to 29 years, with an average of 1.5 years. The painful neuromas of the fingers were treated with brachial plexus anesthesia, the painful neuromas of the shoulder and axilla were treated with general anesthesia, and the painful neuromas of the lower limbs were treated with subarachnoid anesthesia, and the neuromas were exposed by incising the subcutaneous tissue along the nerve alignment centered on the most obvious painful point, excising the neuromas until normal nerve axons were visible, sending them for pathological examination, with or without intraosseous implantation, flexor tendon sheath implantation, severed end anastomosis, and both sides The nerve is treated with or without intraosseous implantation, flexor tendon sheath implantation, severed end anastomosis, in situ grafting of both sides of the nerve, and flap coverage. The anastomosis and implantation of the nerve are performed with a 2X-4X surgical microscope, 6-0/8-0 non-invasive wire, and non-invasive intraoperative techniques. The nerve bed is tightly hemostatic. Regardless of the nerve treatment, the outer membrane of the nerve is not excessively stripped and the nerve must be placed in a tissue with abundant blood flow and less likely to produce scarring. The nerve must be placed in a tissue with rich blood flow and less likely to produce scarring. Drainage is placed in the operative area. III. Postoperative treatment Postoperative antibiotics were routinely applied to prevent infection by adequate drainage. Results Postoperative follow-up ranged from 2 years to 30 years, with an average of 3 years. All patients had good wound healing and no infection. The follow-up was evaluated by the improvement of patients’ pain, patients’ subjective, etc. Excellent:spontaneous pain and tenderness disappeared; patients were satisfied. Good: spontaneous pain disappeared, occasional tenderness; patient satisfaction. Poor: ineffective or aggravated; patients were not satisfied. There were 8 cases of neuroma tumor resection, 3 excellent and 5 good. Disconnected anastomosis (sickle cut of the radial finger nerve of the left middle finger) 1 case, good. One case of intratendinous implantation, excellent. Intraosseous implantation in 5 cases, 3 excellent, 2 good. One case of bilateral nerve stump anastomosis, good. Stump anastomosis in situ grafting in 10 cases, 4 excellent, 5 good, 1 poor. Skin flap covering 7 cases, 4 excellent, 2 good, 1 poor. There were 15 excellent cases, 16 good cases, and 2 poor cases, with an excellent rate of 45.5% and an excellent rate of 93%. The concept of neuroma was first introduced by Odier in 1811, and further reported by Wood, Virdow, and Ched in the early 19th century. They believed that neuromas were the result of a failure to sever the nerve to re-establish normal continuity . It has been suggested that there is a delicate and long-term balance between the protective effect of the proliferation of the injured nerve epineurium and the nerve injury, wound and scar compression. This balance can be easily disrupted by contact, compression, vibration and temperature changes, leading to sudden changes in the release of extracellular signaling molecules, cytokines and ions from the neuroma, producing neuroma symptoms, and repeated stimulation can cause acute exacerbation of neuroma symptoms or enlargement of the tumor[2] In the present situation where the formation mechanism of painful neuroma is not fully understood, different treatment methods for painful neuroma in different sites should be reasonable. For finger stumps, venous bridging and nerve grafting are preferred; for forearm stumps, neuromuscular sutures are mostly used; for high limb neuromas, neuromuscular sutures can be considered. If clinical conditions permit, the stump can be considered to be treated at the time of emergency or initial surgery, and nerve sparing or reconstruction of nerve continuity can be performed by the above corresponding methods to prevent neuroma formation [7]. If the above treatments are not effective, vascularized fascial flap treatment may be considered. In our study, we found that the treatment effect of painful neuromas is not so much correlated with the type of surgery used, but with the gentle operation during surgery, no excessive stripping of the nerve epithelium, reasonable treatment of the nerve bed, rich blood flow in the nerve bed, tight hemostasis, postoperative scar production; psychological condition and the time and degree of limb and nerve damage to the beginning of pain. The improvement of neuroma symptoms after surgery is also related to the patient’s different life background, education level, and whether compensation is involved. These factors can affect the patient’s psychological status, and the psychological reinforcement can act centrally and locally on the nerve, affecting postoperative neuroma symptoms. Although there is no significant difference in neuroma symptom relief between surgical approaches, there is a more reasonable choice of surgical approach for the operator and the site of the neuroma. The author’s left little finger was cut by glass on the radial side, with a skin wound of approximately 50px from the middle phalanx to the distal interphalangeal joint, with no jet bleeding, normal activity, and good peripheral blood flow sensation. The wound was healed well with a hospital emergency debridement and suturing. The symptoms of neuroma were reduced after 1.5 years, and the rougher objects could be touched by the neuroma site, but there was still suffocating pain when squeezing hard, but it had almost no effect on life and work. If we treat the painful neuroma with a positive attitude, it is possible to achieve “survival with tumor”. Neuropathic pain and hypersensitivity at the damaged area of neuroma are caused by the damage of nerve conduction pathway, which leads to the loss of sensation and dysregulation of the nervous system, and these changes can be divided into peripheral sensitization and central sensitization. Peripheral sensitization mainly consists of injury receptor sensitization leading to spontaneous injury receptor activation, threshold reduction, and enhanced response to suprathreshold stimuli. In contrast, central sensitization may be associated with a large number of intensive peripheral hypersensitivity inputs. According to our clinical observation and the author’s own experience, the repeated stimulation due to discomfort of the limb stump and the ensuing psychological effects can aggravate and accelerate the development of peripheral sensitization and central sensitization. That is, discomfort in the limb stump is the main cause of neuroma hypersensitivity and aggravation of pain symptoms, while deliberate protection of the neuroma site, avoidance and care for improving skin color, morphology, and elasticity, and application of the mirror theory [9] can protect the patient’s psychology. And the literature is appropriate to support that repeated stimulation can cause acute exacerbation of neuroma symptoms or tumor enlargement.