A consecutive series of targeted muscle reinnervation (TMR) cases for relief of neuroma and phantom limb pain: UK perspective

Kang, Norbert; Woollard, Alexander; Michno, Dominika; Al-Ajam, Yazan; Tan, Jaclyn; Hansen, Esther

doi:10.1016/j.bjps.2021.09.068

Cited by 20 publications

(42 citation statements)

References 21 publications

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“…A reduction of 2 points, or 30%, represents a clinically important difference in pain [29] . By this measure, clinically significant improvements in both PLP and RLP were seen, of 2.6 and 3.2, respectively, as well as improvements in general limb pain as documented by two authors, with a reduction of 2.8 [7,14,18,21,22] .…”

Section: Discussionsupporting

confidence: 53%

“…This reorganization could explain why secondary TMR benefits for pain could be blunted in comparison to primary TMR [28] . The data from Dumanian et al and Mioton et al both suggest that PLP and RLP can still benefit from secondary TMR, even years after amputation, especially compared to conventional neuroma excision and nerve end burying into muscle techniques [7,21] . The median time to TMR after amputation in Dumanian et al was 5-9 years and 1-4 years in Mioton et al [7,21] .…”

Section: Discussionmentioning

confidence: 99%

“…Five studies reported pain scores with NRS. [7,21,22] . Hoyt et al and Chang et al totaled 89 patients and presented a mean decrease in general pain score of 2.8 points from the last follow-up to baseline [14,18] [Table 6].…”

Section: Tmr For Secondary Treatment Of Painmentioning

confidence: 99%

“…The average decrease in PLP intensity, behavior and interference T-scores were 8.36, 5.70 and 7.76, respectively. The average decrease in RLP intensity, behavior and interference T-scores were 9.74, 4.21 and 8.37, respectively [7,21] [Table 7].…”

Section: Tmr For Secondary Treatment Of Painmentioning

confidence: 99%

“…The studies reporting NRS, VAS, and/or PROMIS scores included some upper extremity TMR patients. Of the five studies, 19.9% (39/196 limbs) of the TMR limbs were upper extremities [7,14,21,22] . The summarized results of Pet et al excluded all upper extremity TMR patients [19] .…”

Section: Tmr For Secondary Treatment Of Painmentioning

confidence: 99%

See 4 more Smart Citations

A review of pain outcomes following targeted muscle reinnervation in lower extremity limb pain

Le¹,

Greyson²,

Constantine³

et al. 2022

Plast Aesthet Res

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Approximately 75% experience phantom (PLP), residual (RLP), or general (GLP) limb pain following lower extremity amputation. Targeted muscle reinnervation (TMR) is a peripheral nerve transfer that reroutes amputated nerves to motor endplates that can prevent or treat limb pain. This systematic review summarizes pain outcomes following primary and secondary treatment of lower extremity PLP, RLP, and GLP. Primary literature review of three databases - PubMed, EMBASE, MEDLINE - were used for all articles related to TMR and lower extremity limb pain, querying the same keywords: “targeted muscle reinnervation” AND “pain”. Citations were then reviewed and eliminated if only upper extremities were studied or the study lacked pain outcomes. Citations were categorized as primary or secondary TMR. Pain outcomes, including Numerical Rating Scales (NRS) and Patient-Reported Outcome Measurement Information System (PROMIS) Pain scores, were aggregated when appropriate. Ten studies met all inclusion and exclusion criteria after formal review for a total of 431 extremities, of which 79.1% (n = 341 limbs) were lower extremities. Average primary TMR PROMIS scores for PLP and RLP were lower than amputees without primary TMR. Average NRS scores and PROMIS Pain scores in secondary TMR demonstrated improvements in PLP, RLP, and GLP. Primary and Secondary TMR does prevent and improve PLP, RLP, and GLP; however, a minority of studies report quantifiable pain outcomes. All future TMR studies should include validated pain outcomes to better quantify the expected pain and quality of life improvements after lower extremity TMR.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Tmr For Secondary Treatment Of Painmentioning

confidence: 99%

Section: Tmr For Secondary Treatment Of Painmentioning

confidence: 99%

Section: Tmr For Secondary Treatment Of Painmentioning

confidence: 99%

See 3 more Smart Citations

A review of pain outcomes following targeted muscle reinnervation in lower extremity limb pain

Le¹,

Greyson²,

Constantine³

et al. 2022

Plast Aesthet Res

View full text Add to dashboard Cite

show abstract

The application of targeted muscle reinnervation in lower extremity amputations: A systematic review

et al. 2023

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BackgroundTargeted muscle reinnervation (TMR) is a promising surgical modality for reducing post‐amputation pain. We sought to provide a succinct overview of TMR specific to the lower extremity (LE) amputation population.MethodsA systematic review was performed per PRISMA guidelines. Ovid MEDLINE, PubMed, and Web of Science were queried for records using various combinations of Medical Subject Heading (MeSH) terms such as “LE “amputation,” “below‐knee amputation” (BKA), “above‐knee amputation” (AKA), and “TMR.” Primary outcomes included (1) operative techniques, (2) changes in neuroma, phantom limb pain (PLP), or residual limb pain (RLP), and (3) postoperative complications. Studies were only included if outcomes data were discretely provided for LE patients.ResultsEleven articles examining 318 patients were identified. Average patient age was 47.5 ± 9.3 years, and most patients were male (n = 246, 77.4%). Eight manuscripts (72.7%) described TMR at the index amputation. The average number of nerve transfers performed per TMR case was 2.1 ± 0.8, and the most commonly employed nerve was the tibial (178/498; 35.7%). Nine (81.8%) articles incorporated patient‐reported outcomes after TMR, with common methods including the Numerical Rating Scale (NRS) and questionnaires. Four studies (33.3%) reported functional outcomes such as ambulation ability and prosthesis tolerance. Complications were described in seven manuscripts (58.3%), with postoperative neuroma development being the most common (21/371; 7.2%).ConclusionsThe application of TMR to LE amputations is effective in reducing PLP and RLP with limited complications. Continued investigations are warranted to better understand patient outcomes specific to anatomic location using validated patient‐reported outcome measures (PROM).

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Insights into optimizing phantom pain management: A human‐centered approach to end‐user perspectives

Mareboina,

Bastian,

Juengst

et al. 2024

PM&R

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BackgroundThis report explores and summarizes perspectives from end users on unmet needs in achieving optimal and effective phantom pain management through a human‐centered design approach.ObjectiveTo examine current strategies, pharmacological, nonpharmacological, surgical procedures, virtual reality, and mirror therapy, and the evidence supporting them, in the management of phantom limb pain.DesignThis study reviewed and analyzed transcripts acquired in nonresearch contexts from the Veterans Affairs Translational Education and Mentoring Center's commercialization training program and from a Veteran Engagement Panel. Key themes were extracted using quasi‐qualitative analysis of one‐on‐one interviews.ResultsClinicians and patients report that early patient intervention and education will yield improved management of phantom limb pain, which aligns with the growing recognition of the impact of patient‐centered care on overall treatment outcomes. Mirror therapy is viewed as an effective and low‐risk therapy, though compliance and buy‐in may be barriers to clinical practice. Patient engagement can contribute to better treatment adherence and outcomes.ConclusionThe study highlights implementation barriers, importance of end‐user input, and the role of the Veteran Engagement Panel in providing feedback to pain researchers. The findings help explain unaddressed challenges and areas requiring further research to direct phantom pain management.

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A consecutive series of targeted muscle reinnervation (TMR) cases for relief of neuroma and phantom limb pain: UK perspective

Cited by 20 publications

References 21 publications

A review of pain outcomes following targeted muscle reinnervation in lower extremity limb pain

A review of pain outcomes following targeted muscle reinnervation in lower extremity limb pain

The application of targeted muscle reinnervation in lower extremity amputations: A systematic review

Insights into optimizing phantom pain management: A human‐centered approach to end‐user perspectives

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