Targeted muscle reinnervation (TMR) has been shown to reduce phantom limb pain and residual limb pain after major limb amputation. Because the effect of the timing of surgery on pain control and quality of life outcomes is controversial, a team of researchers conducted a retrospective study to compare the outcomes of acute TMR for pain prevention with non-acute TMR for the treatment of established pain.
Acute TMR was associated with clinically and statistically significant pain outcomes that were better than that in non-acute TMR, which suggests that TMR should be performed with preventive intent, when possible, as part of a multidisciplinary approach to pain management, rather than deferred until the development of chronic pain, according to the related study.
All patients treated with TMR at the Alfred Hospital, Australia, between January 2018 and December 2021 were evaluated at six, 12, 18, and 24 months post-operatively. Pain intensity and quality of life outcomes were assessed using the Brief Pain Inventory (Pain Severity and Pain Interference scales) and Pain Catastrophizing Scale. The research team compared outcomes between acute and non-acute TMR using the Wilcoxon ranked-sum test or Fisher’s exact test as appropriate. Multilevel mixed-effects linear regression was used to account for repeat measures and potential pain confounders.
Thirty-two patients with 38 major limb amputations were included. Acute TMR patients reported significantly lower residual limb pain and phantom limb pain scores, pain interference, and pain catastrophization at all time points. Acute TMR was significantly associated with lower pain severity and pain interference in a linear mixed-effects model accounting for patient age, gender, amputation indication, amputation site, time since TMR, and repeated surveys. The researchers found no significant difference in the complication rate.
The study, “Acute versus non-acute targeted muscle reinnervation for pain control following major limb amputation: A comparative study,” was published in the Journal of Plastic, Reconstructive & Aesthetic Surgery.
