Managing Neuroma and Phantom Limb Pain in Ontario: The Status of Targeted Muscle Reinnervation

Abstract

Background: Painful neuromas (PN) and phantom limb pain (PLP) are common following amputation and are unreliably treated, which impacts quality of life. Targeted muscle reinnervation (TMR) is a microsurgical technique that repairs the severed proximal nerve end to a redundant motor nerve in the amputated stump. Evidence supports TMR as effective in treating PN and PLP; however, its adoption has been slow. This study aimed to characterize: (1) the populations experiencing post-amputation PN/PLP; (2) current trends in managing PN/PLP; and (3) attitudes toward routine use of TMR to manage PN/PLP. Methods: A cross-sectional survey was distributed to all orthopedic surgeons, plastic surgeons, and physiatrists practicing in Ontario, via publicly available emails and specialty associations. Data were collected on demographics, experience with amputation, managing post-amputation pain, and attitudes toward routine use of TMR. Results: Sixty-six of 698 eligible participants submitted complete surveys (9.5% response rate). Respondents had a greater experience with surgical management of PN (71% PN versus 10% PLP). However, surgery was considered a 3rd-line option for PN and not an option for PLP in 57% and 59% of respondents, respectively. Thirty participants (45%) were unaware of TMR as an option, and only 8 respondents have currently incorporated TMR into their practice. Many (76%) would be willing to incorporate TMR into their practice as either an immediate or delayed surgical technique. Conclusions: Despite its promise in managing post-amputation pain, awareness of TMR as a surgical option is generally poor. Several barriers to the widespread adoption of this technique are defined.

Minimally Invasive Peripheral Neuromodulation for Postamputation Stump Neuroma: A Case Report

“…Chronic pain is a significant cause of morbidity in patients following amputation. As a result of their pain, patients experience both physical and psychological suffering as their diminished ability to participate in normal activities (4). Despite this, there is no standard protocol for postamputation pain, typically consisting of a combination of medical and surgical management.…”

“…Of these, approximately 25% have secondary neuroma formation (3). Pain due to neuromas significantly impedes prosthesis use and limits normal activities of daily living (4). As a result, many patients have a measurable decline in their quality of life that many attribute to their pain as opposed to the loss of their limb (5).…”