Sex-based differences in pain outcomes and opioid use following prophylactic regenerative peripheral nerve interface...

Area of Science:

• Pain Management
• Surgical Innovation
• Clinical Outcomes

Background:

• Post-amputation pain, including phantom limb pain (PLP), significantly impacts patient quality of life.
• Regenerative peripheral nerve interface (RPNI) surgery is an effective treatment for post-amputation pain.
• Preclinical studies suggest sex-specific differences in pain modulation, but clinical data is limited.

Purpose of the Study:

• To evaluate sex-based differences in pain and medication outcomes following RPNI surgery.
• To compare RPNI surgery with standard nerve techniques in managing post-amputation pain.
• To assess the clinical impact of RPNI on PLP severity and analgesic use.

Main Methods:

• Retrospective cohort study of adult patients undergoing major extremity amputation.
• Comparison of patients receiving RPNI surgery versus standard nerve techniques.
• Propensity score matching used to control for age, amputation level, and comorbidities. Outcomes included PLP scores, neuroma presence, and quantified opioid/benzodiazepine use (MME/day, LME/day).

Main Results:

• RPNI surgery significantly reduced PLP in both sexes over one year, with no difference in pain reduction trajectory.
• Males reported higher overall PLP severity, but opioid use decreased significantly in both sexes after RPNI.
• Females showed a greater reduction in opioid use post-RPNI, but higher overall MME/day compared to males.

Conclusions:

• RPNI surgery is effective in reducing PLP and medication requirements for both male and female patients.
• Sex-specific differences in pain perception and analgesic use warrant consideration for personalized postoperative pain management strategies.
• RPNI surgery offers a significant benefit in managing post-amputation pain, with notable sex-based variations in outcomes.