Journal CME, November 2023: Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic review-Journal CME, November 2023: Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic review

Journal CME, November 2023: Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic review

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Pdf Summary

Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interfaces (RPNI) are two surgical techniques that are gaining popularity for the management of nerve pain following amputations and peripheral nerve injuries. A systematic review of the literature was conducted to assess the effectiveness of these techniques in preventing and treating pain. The review included 17 studies, with 14 evaluating TMR and 3 evaluating RPNI. <br /><br />For pain treatment, TMR and RPNI showed improvements in neuroma pain in 75-100% of patients and phantom limb pain in 45-80% of patients. On average, patients experienced a reduction in pain scores of 2.4-6.2 points on the numeric rating scale after surgery. When TMR or RPNI was performed prophylactically at the time of amputation, many patients reported no neuroma pain (48-100%) or phantom limb pain (45-87%) at follow-up. <br /><br />Six TMR studies reported Patient-Reported Outcomes Measurement Information System (PROMIS) scores, which consistently showed a benefit for all measures assessing pain intensity, behavior, and interference. Complication rates ranged from 13-31%, most commonly delayed wound healing. <br /><br />The study concluded that TMR and RPNI may be beneficial for preventing and treating pain originating from peripheral nerve dysfunction compared to traditional techniques. However, more randomized trials with longer-term follow-up are needed to directly compare the effectiveness of these techniques with traditional nerve management techniques.

Keywords

Targeted Muscle Reinnervation

Regenerative Peripheral Nerve Interfaces

nerve pain

amputations

peripheral nerve injuries

systematic review

neuroma pain

phantom limb pain

PROMIS scores

complication rates