Is there a satisfactory method for reducing the frequency or intensity of phantom or residual limb pain after amputation? In a paper published in the Journal of the American College of Surgeons, Valerio and colleagues[1] presented their results on performing a targeted muscle reinnervation (TMR) procedure, a technique of suturing a transected nerve to one of the nerves within a nearby muscle, at the time that patients underwent major limb amputation.
The authors performed this procedure in a group of 51 patients and compared the results with those of a larger group of 438 patients who did not have this procedure. Information about pain was obtained by asking patients to complete and return survey forms. Minimum follow-up time was 3 months, and for most patients the time interval from operation to pain evaluation was more than 1 year. Patients undergoing the nerve preimplantation procedure had less pain than patients undergoing conventional amputations as measured by best, current, and residual pain scores (P < .001). The nerve transplant group also experienced less phantom pain (P < .001).
Should TMR Be Routine at the Time of Amputation?
Nerve pain or the sensation of a phantom limb are common complaints after amputation, and prevention of these neurologic complications continues to be a surgical goal.
