Psychosocial outcomes after targeted muscle reinnervation in patients with neuropathic pain

Neuropathic pain significantly impacts quality of life (QoL), mental health, and function. Targeted muscle reinnervation (TMR) is an intervention that can effectively treat and prevent neuropathic pain, but its effects on psychosocial outcomes remain underexplored. This study evaluates psychosocial outcomes after TMR surgery for neuropathic pain in amputees (both primary [pTMR] and secondary [sTMR]) and non-amputees.

In this prospective study, 46 patients (15 sTMR, 19 pTMR, 12 non-amputees) who underwent TMR for neuropathic pain management were assessed for psychosocial outcomes. Preoperative and postoperative surveys measured pain catastrophizing (Patient-Reported Outcomes Measurement Information System [PROMIS]), depression (Patient Health Questionnaire-2 [PHQ-2]), anxiety (Generalized Anxiety Disorder-2 [GAD-2]), sleep metrics (PROMIS sleep disturbance, sleep duration), and QoL (World Health Organization Quality of Life assessment [WHOQOL-2]). Mean follow-up duration was 1.5 ± 0.8 years.

Pain catastrophizing significantly decreased across all groups (overall from 50.39 ± 6.24 to 42.41 ± 4.40, P < .001). Depression and anxiety scores improved significantly in the non-amputee and pTMR groups but not in sTMR patients. Sleep disturbance decreased significantly in all groups (from 59.67 ± 8.64 to 51.82 ± 8.01, P < .001), whereas sleep duration increased (from 5.32 ± 1.63 to 6.09 ± 1.29 hours, P < .001). QoL scores improved significantly across all groups (from 2.45 ± 0.87 to 3.43 ± 0.62, P < .001). Patients with psychiatric comorbidities (60.9%) showed similar improvements, despite having higher preoperative and postoperative depression and anxiety scores.

Patients who underwent TMR for neuropathic pain management demonstrated improved psychosocial outcomes. Non-amputees and pTMR patients demonstrated greater improvements in depression and anxiety than did sTMR patients. Sleep quality and duration improved substantially, a previously underreported benefit of TMR. Future, larger prospective studies should further validate relationship between neuropathic pain reduction through TMR and psychosocial outcomes.