Targeted Muscle Reinnervation for Surgical Pain Management in Amputees: Clinical Case Series at an Academic Medical Institution
Cameron Cox, BBA1, Joash R Suryavanshi, BA1, Desirae McKee, MD1, Nancy E Swinford, R.T. (R)(ARRT), CCRC2, Bradley Osemwengie, BA1 and Brendan J MacKay, MD1, (1)Texas Tech University Health Sciences Center, Lubbock, TX, (2)Texas Tech University Health Science Center, Lubbock, TX
Introduction
There are approximately 1.7 million amputees currently living in the United States, and the number continues to rise. These patients are often left with chronic localized pain due to symptomatic neuromas in the residual limb. Targeted Muscle reinnervation (TMR) is a novel surgical nerve-transfer procedure that involves transfer of residual nerves from amputated limbs to new muscle targets. TMR has been shown to significantly reduce neuroma pain, especially when compared to other surgical treatment options. While TMR has demonstrated utility in pain management for amputees, the majority of current literature covers animal studies, military populations, or the institution where TMR was first developed. We present preliminary data on a series of cases at an academic hospital in a heterogenous population.
Materials & Methods
Patients who underwent TMR for neuroma treatment or prevention were included in our cohort. Overall pain score, phantom pain, stump pain, and nerve pain were recorded using the VAS pain scale. PROMIS forms for Pain Intensity, Quality, Interference, and Behavior were collected when possible. Any complications related to TMR were noted.
Results
This series included 35 patients who underwent TMR for neuroma treatment or prevention in 41 limbs. Four patients in our cohort had TMR performed on multiple limbs - 1 patient had 4-limb TMR, 1 had bilateral upper extremity amputations, and 2 had bilateral lower extremity amputations.
The average age of included subjects was 45.5 (range: 19-64). Twenty-four patients (66%) were male. In our cohort, there were 15 upper extremity amputations (9 right, 6 left) and 26 lower extremity amputations (13 right, 13 left).
Average overall, phantom, stump, and nerve pain were 1.9 (n = 25, range: 2-5), 2.6 (n = 26, range: 0-10), 1.0 (n = 25, range: 0-7), and 2.1 (n = 21, range: 0-8), respectively at most recent follow up (mean = 7.8 months, range: 0.2-21.4). Average PROMIS scores for Pain Intensity, Quality, Interference, and Behavior were 44.5, 50.7, 54.1, and 53.6, respectively at most recent follow up (n = 12, mean = 6.8 months, range 0.2-16.2). There were no reported complications related to the TMR procedures.
Conclusion
All patients present in this case series show improvement of neuropathic pain symptoms after TMR, without complication or revision related to the procedure. This study further establishes TMR as an effective therapy for the management of neuroma pain after limb amputation.
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