Targeted Muscle Reinnervation as a Surgical Approach for Phantom Limb Pain Management Following Amputation

2021 ◽  
Author(s):  
Nikhil Agrawal ◽  
Lisa Gfrerer ◽  
Marilyn Heng ◽  
Kyle R. Eberlin ◽  
Ian Valerio
Keyword(s):  
Pain Management ◽  
Surgical Approach ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation

scholarly journals Targeted muscle reinnervation in quadruple amputees: self-reported outcomes

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Emma-Leigh Rudduck ◽  
Frank Bruscino-Raiola ◽  
Margaret Angliss ◽  
Steven J Gray ◽  
David Lee Gow ◽  
...  
Keyword(s):  
Current Literature ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Residual Limb ◽  
Limb Pain ◽  
Targeted Muscle Reinnervation ◽  
Alfred Hospital ◽  
Muscle Reinnervation ◽  
Residual Limb Pain ◽  
Psychological Disabilities

Targeted muscle reinnervation (TMR) reduces pain and physical and psychological disabilities in amputees. We present the first two cases reported globally of quadruple amputees that underwent acute TMR. Each patient completed our novel ‘The Alfred Hospital Osteointegration Survey’ (TAHOS) for each limb at six, 12 and 24 months post amputation which evaluated aspects of prosthesis wear, neuroma-related residual limb pain (RLP), phantom limb pain (PLP) and overall function. Our findings that TMR reduced or eliminated RLP and PLP by 12 months and clinically improved prosthetic function in both quadruple amputees reflects the current literature for single and multiple limb amputees.

Challenges and Potential in Targeted Muscle Reinnervation in Pediatric Amputees

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Brian Vial ◽  
Margaret Lieb ◽  
Haley Pysick ◽  
Patrick Hettinger ◽  
Lynn Rusy ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Complete Relief ◽  
Residual Limb ◽  
Limb Pain ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation

Targeted muscle reinnervation (TMR) is a powerful new tool in preventing and treating residual limb and phantom limb pain. In the adult population, TMR is rapidly becoming standard of care; however, there is a paucity of literature regarding indications and outcomes of TMR in the pediatric population. We present 2 cases of pediatric patients who sustained amputations and the relevant challenges associated with TMR in their cases. One is a 7-year-old patient who developed severe phantom and residual limb pain after a posttraumatic above-knee amputation. He failed pharmacologic measures and underwent TMR. He obtained complete relief of his symptoms and is continuing to do well 1.5 years postoperatively. The other is a 2-year-old boy with bilateral wrist and below-knee amputations as sequelae of sepsis. TMR was not performed because the patient never demonstrated evidence of phantom limb pain or symptomatic neuroma formation. We use these 2 cases to explore the challenges particular to pediatric patients when considering treatment with TMR, including capacity to report pain, risks of anesthesia, and cortical plasticity. These issues will be critical in determining how TMR will be applied to pediatric patients.

A consecutive series of targeted muscle reinnervation (TMR) cases for relief of Neuroma and Phantom Limb Pain: UK perspective.

2021 ◽  
Author(s):  
Mr Norbert Venantius Kang ◽  
Mr Alexander Woollard ◽  
Miss Dominika Antonina Michno ◽  
Mr Yazan Al-Ajam ◽  
Miss Jaclyn Tan ◽  
...  
Keyword(s):  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Consecutive Series ◽  
Limb Pain ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation

Interventional pain management for phantom limb pain: An algorithmic approach

2012 ◽  
Vol 16 (4) ◽  
pp. 201-204
Author(s):  
Santiago Jaramillo ◽  
Lizeth Jazmin Ramirez ◽  
Carlos Eduardo Restrepo-Garces ◽  
Carlos Mario Gómez B ◽  
Juan Felipe Vargas Silva
Keyword(s):  
Pain Management ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Algorithmic Approach ◽  
Interventional Pain Management

scholarly journals Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Roberta De Jong ◽  
Alexander J. Shysh
Keyword(s):  
Pain Management ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Multimodal Analgesia ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Multiple Sources ◽  
Limb Pain ◽  
Pain Mechanisms

Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.

Risk Factors for Neuropathic Pain Following Major Upper Extremity Amputation

2020 ◽  
Author(s):  
Jonathan Lans ◽  
Yannick Hoftiezer ◽  
Santiago A. Lozano-Calderón ◽  
Marilyn Heng ◽  
Ian L. Valerio ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Upper Extremity ◽  
Multivariable Analysis ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Targeted Muscle Reinnervation ◽  
Medical Chart Review ◽  
Increased Risk ◽  
Extremity Amputation

Abstract Background Active treatment (targeted muscle reinnervation [TMR] or regenerative peripheral nerve interfaces [RPNIs]) of the amputated nerve ends has gained momentum to mitigate neuropathic pain following amputation. Therefore, the aim of this study is to determine the predictors for the development of neuropathic pain after major upper extremity amputation. Methods Retrospectively, 142 adult patients who underwent 148 amputations of the upper extremity between 2000 and 2019 were identified through medical chart review. All upper extremity amputations proximal to the metacarpophalangeal joints were included. Patients with a follow-up of less than 6 months and those who underwent TMR or RPNI at the time of amputation were excluded. Neuropathic pain was defined as phantom limb pain or a symptomatic neuroma reported in the medical charts at 6 months postoperatively. Most common indications for amputation were oncology (n = 53, 37%) and trauma (n = 45, 32%), with transhumeral amputations (n = 44, 30%) and shoulder amputations (n = 37, 25%) being the most prevalent. Results Neuropathic pain occurred in 42% of patients, of which 48 (32%) had phantom limb pain, 8 (5.4%) had a symptomatic neuroma, and 6 (4.1%) had a combination of both. In multivariable analysis, traumatic amputations (odds ratio [OR]: 4.1, p = 0.015), transhumeral amputations (OR: 3.9, p = 0.024), and forequarter amputations (OR: 8.4, p = 0.003) were independently associated with the development of neuropathic pain. Conclusion In patients with an upper extremity amputation proximal to the elbow or for trauma, there is an increased risk of developing neuropathic pain. In these patients, primary TMR/RPNI should be considered and this warrants a multidisciplinary approach involving general trauma surgeons, orthopaedic surgeons, plastic surgeons, and vascular surgeons.

Sign in / Sign up

Export Citation Format

Share Document