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Targeted Reinnervation in the Amputee, Pain Update
Hehr JD, Bowen JB, Ruter DI, Jordan SW, Wee CE, West JM, Valerio IL.
Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, C
2018-02-15
Presenter: Jason D Hehr, MD
Affidavit:
Jason Hehr adequately participated in this research.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Chronic, painful neuromas (PN) and/or phantom limb pain (PLP) commonly occur in major limb amputees. Prior studies have demonstrated the effectiveness of Targeted Reinnervation (TR) in treatment of PN, PLP. Here, we expand upon original cohort data to show that concurrent TR at time of amputation reduces incidence of PN/PLP.
Methods: All patients undergoing TR at our institution by the senior author have been included and evaluated using the Patient Report Outcomes Measurement Information System (PROMIS) questionnaire and patient reported pain using standard numeric rating scale (NRS).
Results: 40 patients underwent primary TR at time of amputation, for both upper and lower extremities. Oncologic (42.5) and traumatic (35%) indications for amputation were most common. When compared against our general amputee cohort, those patients undergoing primary TR showed a statistically significant decrease across all PROMIS endpoints and NRS for pain. 17 of 40 (42.5%) patients undergoing primary TR reported no PLP post-operatively, as compared to 27% of control group. Additionally, 19 of 40 (47.5%) reported a pain-free residual limb, or no PN's, as compared to 25% of control group.
Conclusions: This TR update indicates that primary TR is beneficial in preventing both the development of painful neuromas as well as PLP. This new data suggests that primary TR may alter pain referral pathways via early feedback and neuromodulation. Ultimately, primary TR reduces pain, accelerating recovery and improving amputee function.
