Targeted Muscle Reinnervation in Managing Postamputation-Related Pain

While targeted muscle reinnervation (TMR) is a promising approach to pain management in amputees, there is not enough high-quality evidence to support its use in reducing postamputation phantom limb pain (PLP) and residual limb pain (RLP) pain compared with the standard of care, according to study results published in Pain Practice.

Used increasingly in the management of neuroma-related PLP and RLP, TMR has been shown to improve prosthetic function and improve quality of life for amputees by reducing PLP. Study authors sought to evaluate the quality and strength of evidence for effectiveness of TMR in managing pain related to amputation.

For their review, the authors searched the MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase databases from their inception to March 2022. Eligible studies were clinical trials or observational studies published in English that compared preoperative and postoperative pain outcomes or different techniques for adult patients who underwent TMR following amputation, and used the Patient-Reported Outcome Measures Information System (PROMIS).

A total of 127 patients were included in the reviewed 5 qualitative analyses and 4 quantitative analyses. At 12 months follow-up, the TMR group showed better PLP and lower pain intensity compared with standard treatment (mean difference [MD]=−2.33; 95% CI, −3.21 to −1.45; P <.01). TMR was associated with lower pain intensity when considering PROMIS scores for phantom symptoms vs scores with standard treatment, (MD= −9.67; 95% CI, −12.75 to −6.59; P <.01). Similar results were shown for pain behavior (MD=−7.12; P <.01) and interference with life (MD=−7.90; P <.01).

The TMR group showed lower pain intensity and interference for RLP measured by the PROMIS scores, but TMR was not different from standard treatment in terms of pain behavior. The authors’ sensitivity analysis showed no impact on the reported outcomes except for the PROMIS residual pain behavior after removing data from the randomized clinical trial.

Limitations include the addition of military-related injuries and oncology-related amputations, the retrospective design of the included studies, the potential risk of bias arising from the study design differences, and limited follow-up time of no longer than 12 months.

The authors concluded, “TMR has demonstrated potential in improving the quality of life of patients experiencing PLP and RLP by reducing pain levels, with stronger evidence supporting its efficacy in managing PLP.” They added, “However, there is limited good quality evidence favoring TMR in neuroma management compared to standard care.”