American Association of Plastic Surgeons

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Targeted Muscle Reinnervation (TMR) for Treatment and Prevention of Neuroma and Phantom Limb Pain
Ian L. Valerio, MD1, Lauren Mioton, MD2, Byers Bowen, MD1, Sumanas Jordan, MD1, William J. Ertl, MD3, George P. Nanos III, MD4, Scott M. Tintle, MD4, Benjamin K. Potter, MD4, Jason M. Souza, MD4, Jason H. Ko, MD2, Gregory A. Dumanian, MD2.
1The Ohio State University, Columbus, OH, USA, 2Northwestern University, Chicago, IL, USA, 3Oklahoma University Health Sciences Center, Oklahoma City, OK, USA, 4Walter Reed National Military Medical Center, Bethesda, MD, USA.

PURPOSE: A majority of amputees suffer from chronic local pain and phantom limb pain (PLP). There are no reliable means to prevent either neuroma formation or PLP at the time of amputation. We hypothesized that TMR is effective at the treatment and prevention of amputee neuroma-related and phantom pains.
METHODS: The Patient Reported Outcome Measurement Information System (PROMIS) was used to assess stump pain and PLP in untreated amputees, amputees undergoing TMR at the time of a major limb amputation, and in amputees with established severe pain and PLP.
RESULTS: 26 patients who underwent TMR in the acute setting and 21 established amputees in pain were compared to 768 unselected amputees from the general US population. Patients with established painful amputations had statistically greater stump pain and PLP behavior, intensity, and interference than the amputee baseline. TMR significantly improved both chronic local pain and PLP in comparison to preoperative values. Dramatic results were obtained for patients undergoing TMR at the time of major limb amputation who graded their pain and PLP to be almost non-existent.
CONCLUSION: TMR is preventative of neuroma-related pain and phantom limb discomfort. TMR performed in established amputees with chronic pain is effective, but not as effective as when performed acutely at the time of major limb amputation. This is the first documented beneficial treatment of amputee neuroma pain and phantom discomfort.


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