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Does Targeted Muscle Reinnervation (tmr) And Regenerative Peripheral Nerve Interfaces (rpni) Improve Post-amputation Pain? A Systematic Review And Meta Analysis
Abdul Aziz Elemosho
Syed Ali Farhan, MD
Muhammad Moiz Nasir
Jude Kluemper, MD
Kerry-Ann Mitchell, MD
Jason Manuel Souza, MD
Ohio State University
2024-02-01
Presenter: Syed Ali Farhan, MD
Affidavit:
Yes I certify
Director Name: Jason Manuel Souza
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Individuals with extremity amputation suffer from multi-faceted pain, including residual limb pain (RLP) and phantom limb pain (PLP). Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are reconstructive techniques to alleviate post-amputation pain and augment prosthesis function. This systematic review and meta-analysis aimed to aggregate the current evidence on TMR and/or RPNI for improving post-amputation PLP and RLP.
Methods:
A systematic review of the 5 main databases was conducted. Articles comparing patients who had either TMR or RPNI before or at the time of their amputation to those who had traditional amputation were included. Case series, reports, review articles, and other systematic reviews and meta-analyses were excluded. Statistical analyses were performed, and p<0.05 was considered significant.
Results
A total of 972 patients were included in the final analysis, of which 632 were male (65%). Pooled analysis revealed that TMR when compared to standardized care showed significant reduction in any type of pain (RR: 0.52 (95% CI: 0.38, 0.70) P<0.0001, I2 = 23%), phantom limb pain (PLP) (RR: 0.56 (95% CI: 0.46,0.69) P<0.00001, I2 = 4%), and residual limb pain (RLP) (RR: 0.56 (95% CI: 0.34, 0.90) P=0.02, I2=85%).
Conclusion
This systematic review and meta-analysis found that TMR and RPNI significantly decreases both PLP and RLP in the post-amputation setting when compared to standard care. Implementation of While these results are promising, this data further demonstrate that studies comparing the efficacy of RPNI and TMR are lacking.
