TMR on Transtibial Amputees Reduces Initial Phantom Limb Pain
January 02, 2019
Physicians at The Ohio State University Wexner Medical Center and College of Medicine are pioneering the use of primary targeted muscle reinnervation (TMR) to prevent or reduce debilitating phantom limb and residual limb pain in individuals with transtibial amputations.
Primary TMR has shown to reduce phantom limb and residual limb pain, as reported in recent publications by Ian Valerio, MD, division chief of Burn, Wound and Trauma in Ohio State's department of Plastic and Reconstructive Surgery, and J. Byers Bowen, MD, a former resident now in private practice. Their latest work has been published in the January issue of Plastic and Reconstructive Surgery.
The surgeons performed 22 TMR surgeries on patients with transtibial amputations during a three-year time period. None of the patients has developed symptomatic neuromas and 13 percent of patients who received primary TMR reported having pain six months later.
"A significant amount of pain in amputees is caused by disorganized nerve endings, i.e. symptomatic neuromas, in the residual limb. They form when nerves are severed and not addressed, thus they have nowhere to go," Valerio said. "Attaching those cut nerve endings to motor nerves in a nearby muscle allows the body to re-establish its neural circuitry. This alleviates phantom and residual limb pain by giving those severed nerves somewhere to go and something to do."
Valerio also said patients who've had TMR significantly reduce or sometimes stop using narcotics and other nerve pain related medications.
"TMR has been shown to reduce pain scores and multiple types of pain via a variety of validated pain surveys. These findings are the first to show that surgery can greatly reduce phantom and other types of limb pain directly," he said.
Editor's note: This story was adapted from materials provided by The Ohio State University.