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Virtual Pain Surveillance to Increase Access to TMR and Prevent Post-amputation Pain
Gunel Guliyeva, MD, Julie M. West, BS, Jason M. Souza, MD
Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center
2023-01-31
Presenter: Gunel Guliyeva, MD
Affidavit:
Jason M. Souza
The student contributed to more than 60% of this work.
Director Name: Jason M. Souza
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE:
Targeted Muscle Reinnervation (TMR) is being increasingly performed at the time of amputation to prevent pain/neuroma formation. Nonetheless, the evidence on TMR's efficacy as a preventative measure is limited. Moreover, the logistics of the primary TMR are complex, as it is challenging for plastic surgeons to be present at every amputation OR. Therefore, targeted interventions and well-designed studies are needed to assess the efficacy of primary TMR surgery and increase access to it.
METHODS:
This will be a single-center, prospective study. Adult patients scheduled for above or below-knee amputation will be identified using My Chart Care Companion. Patients will receive weekly surveys (VAS and PROMIS behavior, intensity, interference). The follow-up will be a minimum of 18 months.
RESULTS:
One hundred forty-eight patients will be included in this study. While patients with mild pain levels (VAS<3) will be treated nonsurgically, patients with VAS scores >7 and between 4-6 will be offered and undergo TMR at 3 months and 6 months, respectively. If the patient undergoes TMR, the second set of weekly surveys will be added.
CONCLUSIONS:
The evidence on TMR is unfortunately far from ideal due to the difficulty of blinding. Thus, there is a need for better means for identification of the patients at risk of developing neuroma pain/with a higher likelihood of benefiting from the TMR surgery.
In addition to bridging the aforementioned gap, this study will enable us to increase patient access to the primary TMR. Furthermore, close follow-up and early surgery will minimize patient suffering/morbidity.
