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Updated: Mar 31, 2026
Author Spotlight: Regenerative Peripheral Nerve Interface (RPNI) Surgery in Postamputation Pain Management
Published on: March 15, 2024
Outcomes Following Regenerative Peripheral Nerve Interface Surgery and Associations With Preoperative Mental Health:
Ahmed Manzoor1,2, Mohammed Khan1,2, Crisanto Macaraeg1
1The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
Purpose:
Preoperative mental health challenges are associated with lower patient-reported outcomes following traumatic hand surgery. However, the association between mental health and recovery following regenerative peripheral nerve interface (RPNI), a surgical treatment option for upper-extremity (UE) neuromas, is not well characterized. This study investigated the outcomes of RPNI for UE neuromas in amputees and nonamputees, and evaluated for associations between preoperative mental health and patient-reported outcomes. We hypothesized that RPNI would improve pain and function, irrespective of baseline mental health or amputation status.
Methods:
A retrospective analysis of point-of-care data was conducted on patients undergoing RPNI for UE neuromas. Patient-reported outcome measures (PROMs) included the numerical 11-point visual analog scale (VAS) for pain, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Global Mental Health (GMH), and Global Physical Health (GPH). Patients were stratified into tertiles based on preoperative GMH scores, with the bottom third defined as "poor" preoperative mental health. Subgroup evaluations compared outcomes between amputees and nonamputees. Paired t tests analyzed changes in PROMs from before to after surgery.
Results:
Overall, VAS scores improved from 6.2 to 3.5, PROMIS UE improved from 29.5 to 31.0, and GPH improved from 40.3 to 41.8. Patients with lowest preoperative mental health scores showed greater VAS improvement (-3.3) than upper tertiles (-2.5). The lowest GMH tertile improved in PROMIS UE and GPH, as did the upper two tertiles. Amputees and nonamputees had comparable VAS improvements (-2.6 vs -2.8).
Conclusions:
Regenerative peripheral nerve interface resulted in clinically and statistically significant improvements in pain reduction (P < .05) with mild improvements in UE function. Patients with lower preoperative mental health scores reported similar or greater pain improvements and similar functional improvements. This suggests that RPNI benefits patients regardless of mental health status. Comparable pain outcomes in amputees and nonamputees support RPNI as a treatment for neuromas.
Type Of Study/Level Of Evidence:
Therapeutic IV.
