American Society for Peripheral Nerve

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Targeted Muscle Reinnervation as a Treatment For Amputee-Related Pain
Lauren Mioton, MD1; Gregory A Dumanian, MD2; Benjamin K Potter, MD3; Jennifer E. Cheesborough, MD4; Jason M. Souza, MD3; Sumanas W Jordan, MD, PhD5; George P. Nanos, MD6; Scott M Tintle, MD7; William J Ertl, MD, PhD8; Ian L. Valerio, MD, MS, MBA9; Vania Apkarian, PhD10; Jason H Ko, MD11
1Northwestern Memorial Hospital, Chicago, IL, 2Northwestern University, Chicago, IL, 3Walter Reed National Military Medical Center, Bethesda, MD, 4Division of Plastic Surgery, Northwestern University, Chicago, IL, 5Ohio State University, Columbus, OH, 6Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, 7Walter Reed National Medical Center, Bethesda, MD, 8University of Oklahoma Medical Center, Oklahoma City, OK, 9Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, (10)Northwestern Unviersity, chicago, IL, (11)Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL

Introduction: A growing population of young soldiers returning from modern military conflict and civilians suffering from diabetes, peripheral vascular disease, and cancer contribute to the nearly two million people living with limb loss in the United States alone. Most amputees suffer from unpredictable neuroma-related residual limb and phantom limb pain. These conditions can profoundly decrease patient function and quality of life, and despite a myriad of proposed therapies, there are no reliable treatment or prevention strategies for amputee-related pain. Targeted muscle reinnervation (TMR) is a surgical procedure initially created to achieve improved prosthetic control by surgically rerouting cut nerve endings to redundant motor nerves. As part of a military-civilian collaboration, TMR was incidentally discovered to ameliorate pain and was thus proposed in this study for the management of amputee-related pain.

Methods: TMR was performed in 36 established major-limb amputees for chronic pain. Pre-operative and post-operative pain outcomes were captured using an eleven-point Numerical Rating Scale.

Results: With an average follow up of over one year, average phantom limb pain decreased from 5.3 (SD 3.3) pre-operatively to 2.8 (SD 2.6) post-operatively (p=0.03). Average residual limb pain also decreased from 5.8 (SD 3.1) pre-operatively to 3.1 (SD 2.8) post-operatively (p=0.01).

Conclusions: Targeted Muscle Reinnervation TMR should be strongly considered for intractable amputee-related pain.

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