People who have lost a limb in an accident, at war, or in other circumstances sometimes experience phantom limb pain or residual limb pain in the missing extremity. Dr. Gregory Dumanian and his colleagues at Northwestern Memorial Hospital created a revolutionary procedure that helps patients with amputations improve their pain called targeted muscle reinnervation (TMR).
What Is Targeted Muscle Reinnervation?
TMR was initially created to help patients control myoelectric prostheses and involves transferring nerve signals to nearby muscles to amplify the electric impulses for sensors to pick up through the skin. This technique was revolutionary because it does not require implanting a foreign object or device and has no wiring or batteries; it works through the body’s peripheral nervous system. By happy accident, Dr. Dumanian and his colleagues realized the procedure also improves phantom limb pain and residual limb pain, especially if TMR is performed at the time of the amputation.
How TMR Decreases Pain and Neuromas
A neuroma is a group of nerve cells that grow in a disorganized fashion where nerves are divided during amputation and often causes pain among amputee patients. Peripheral nerves are severed during amputation, damaging the nerve endings and causing neuromas and phantom limb pain. TMR encourages these nerves to regenerate in a more organized manner, reducing the incidence of neuroma formation and discomfort. Performing TMR during an amputation may prevent neuromas and phantom limb pain but can also improve these sensations in patients with previous amputations.
Research Shows TMR Can Decrease Phantom Limb Pain
Dr. Dumanian is a pioneer in TMR procedures and has published extensively on the topic in peer-reviewed medical journals, such as the Lancet, Plastic and Reconstructive Surgery, the Journal of Bone and Joint Surgery, and the Annals of Surgery. Some of his research was published in 2018 in the Journal of the American College of Surgeons.
In this study, Dr. Dumanian and his colleagues investigated whether TMR could decrease the severity and incidence of residual limb pain and phantom limb pain if performed during major limb amputation in 51 patients. They found that these patients experienced less of both types of pain compared to a control group. Patients who had TMR at the time of amputation reported lower pain intensity, less pain behavior, and fewer interferences. Essentially, the pre-emptive intervention of TMR during limb loss decreased the phantom limb pain rate and reduced residual limb pain caused by neuromas.
Dr. Dumanian and his fellow researchers published the results of a randomized controlled clinical trial on TMR in the Annals of Surgery in 2018. This study investigated if TMR could help patients with existing neuromas or phantom limb pain. They compared TMR to the standard treatment, which addresses postamputation pain by removing the neuroma surgically and burying into the muscle. Twenty-eight amputees with chronic pain were included in the study and assigned TMR or the standard approach. Dr. Dumanian evaluated their pain scores before the procedure and one year later and found that TMR provided a favorable reduction in residual limb pain, improving existing phantom limb pain compared to the standard method.
If you suffer from phantom limb pain or residual limb pain caused by a neuroma, meet with Dr. Dumanian to discuss targeted muscle reinnervation. Contact Northwestern Plastic Surgery to schedule your consultation by calling (312) 695-6022.