Abstract: Targeted Muscle Reinnervation at the Time of Major Limb Amputation Prevents Phantom Limb and Residual Limb Pain (Plastic Surgery The Meeting (September 28

Sunday, September 30, 2018: 10:25 AM

Sumanas W Jordan, M.D., Ph.D. , Division of Plastic Surgery, Feinberg School of Medicine, Chicago, IL

Lauren M Mioton, MD , Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, IL

Ian Valerio, MD, MS, MBA , Department of Plastic & Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, MD

Jason Ko, MD , Department of Surgery, Division of Plastic Surgery, Northwestern University, Chicago, IL

Jason M Souza, MD , Department of Plastic Surgery, Walter Reed National Military Medical Center, Bethesda, MD

Scott M Tintle, MD , Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD

John Byers Bowen, MD , Department of Plastic Surgery, The Ohio State University, Columbus, OH

George P Nanos, MD , Department of Orthopedic Surgery, Walter Reed National Military Medical Center, bethesda, MD

Mickey S Cho, MD , Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX

David M Condon, PhD , Department of Medical Social Sciences, Northwetern University, Chicago, IL

William J Ertl, MD , Department of Orthopedic Surgery, Oklahoma University, Oklahoma City, OK

Benjamin K Potter, MD , Department of Orthopedic Surgery, Walter Reed Natinoal Military Medicl Center, Bethesda, MD

A. Vania Apkarian, PhD , Department of Physiology, Northwestern University, Chicago, IL

Gregory A. Dumanian, MD , Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

Background: Upwards of 75% of major limb amputees suffer from chronic pain, either isolated to the residual limb stump or perceived in the missing limb, known as phantom limb pain. At present time, there are no reliable and reproducible treatments for these chronic pain conditions. Targeted muscle reinnervation is a surgical procedure initially created to achieve improved prosthetic control by rerouting cut nerve endings to redundant motor nerves. As part of a military-civilian collaboration, TMR was incidentally discovered to ameliorate chronic pain and was thus proposed in this study as a potential preventative pain measure when performed concurrently at the time of amputation.

Methods: TMR was performed concurrently in 40 patients undergoing major limb amputation as a preemptive measure for symptomatic neuromas and phantom limb phenomena across four centers. Outcomes were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) and a Numerical Rating Scale and were compared to a cross-section of 727 untreated amputee controls. One-way ANOVA followed by pairwise comparisons of means was conducted between cohorts.

Results: Patients undergoing TMR concurrently with major limb amputation had dramatic improvement in residual limb and phantom limb pain compared to untreated amputee controls across all measures. PROMIS score mean differences for phantom limb pain were 8.1 (CI 5.5–10.7) for Pain Intensity, 8.3 (CI 5.3–11.2) for Pain Behavior and 8.6 (CI 6.0-11.2) for Pain Interference, all p<0.001. Mean differences for residual limb pain were 8.4 (CI 5.4–11.3), 10.1 (CI 6.8–13.5), and 8.9 (CI 5.7–12.1) for PROMIS Pain Intensity, Behavior, and Interference, respectively (all p<.001). Numerical Rating Scale (NRS) data also revealed similar improvements in average residual limb pain (1.98 vs 3.89) and phantom limb pain (2.14 vs 3.96) for concurrent TMR amputees compared to the general amputee population.

Conclusion: Preemptive Targeted Muscle Reinnervation at the time of limb loss should become standard of care for prevention of pathologic phantom and residual limb pain in amputees.

35687 Targeted Muscle Reinnervation at the Time of Major Limb Amputation Prevents Phantom Limb and Residual Limb Pain