Silencing Neuroma Pain-Botulinum Toxin Versus Local Anesthetic Injection

Inclusion Criteria: * Age ≥18 years * History of limb trauma and/or limb amputation at least 3 months prior to enrollment * Clinical diagnosis of neuroma-related pain with focal tenderness and positive - - Tinel sign * Imaging confirmation of neuroma by ultrasound or MRI * Average pain intensity ≥4 on a 0-10 Numerical Rating Scale (NRS) during the week prior to screening * Stable analgesic regimen for at least 14 days prior to enrollment * Ability to provide written informed consent Exclusion Criteria: * Chronic pain condition unrelated to neuroma that predominates clinical symptoms * infection at or near the planned injection site * Known neuromuscular junction disorders (e.g., myasthenia gravis) * Pregnancy or breastfeeding * Botulinum toxin treatment within the previous 4-6 months * Planned surgical neuroma revision during the study period * allergy or hypersensitivity to botulinum toxin or local anesthetics