Targeted Muscle Reinnervation: Innovative Surgery Is Shown to Reduce Phantom Pain
An innovative surgery originally developed for advanced prosthetics also significantly reduces amputee limb pain, according to a clinical study published in the peer-reviewed Annals of Surgery. The findings underscore the procedure’s potential to revolutionize treatment and become the new standard of care for millions of amputees worldwide suffering from often-debilitating chronic pain.
The study – the first-ever published randomized clinical trial for the treatment of post-amputation pain in major limb amputees – found that a procedure called targeted muscle reinnervation (TMR) resulted in a significantly greater reduction in phantom limb pain and trended toward improved residual limb pain, compared to standard treatment for nerve and pain issues.
“This study proves what we’ve seen anecdotally – that TMR is the first major advance in the way we treat residual and phantom limb pain since the onset of amputations thousands of years ago,” says Gregory Dumanian, MD, chief of plastic surgery at Northwestern University’s Feinberg School of Medicine, lead researcher and study author, and originator of the TMR surgical procedure. “Respite from pain means freedom from narcotics, freedom to engage in physical activity, freedom to enjoy time with family and friends, freedom to pursue careers and much more.”
Chronic pain is pervasive among the 2 million amputees across the U.S. and millions more around the world, often leading to reduced prosthetic function, poor quality of life, and dependence on opiates and other pain medication. Respite from pain means freedom from narcotics, freedom to engage in physical activity, freedom to enjoy time with family and friends, freedom to pursue careers and much more.
A frequently cited survey published in 1983 showed that 85 percent of American military veterans reported significant amounts of phantom pain, noting that “few reported treatments were of any value.” Other estimates suggest that as many as 76 percent of amputees experience residual limb pain, and as many as 85 percent suffer from phantom limb pain (PLP), which is the brain’s perception of pain and discomfort seemingly originating in the absent limb.
In contrast, findings from the recent TMR study show that 72 percent of participants who underwent the procedure reported feeling mild or no phantom pain after 18 months, compared with just 40 percent who underwent standard neuroma excision and muscle burying for chronic post-amputation pain. Additionally, 67 percent of patients were free of or felt only mild residual limb pain following TMR, compared to 27 percent who received standard treatment.
The study, funded by the U.S. Department of Defense, included two sites: Northwestern University, led by Dumanian, and Walter Reed National Military Medical Center, led by Dr. Kyle Potter.