TMR and RPNI Sustainably Reduce Long-Term Pain and Opioid Use after Oncologic Amputation: A Comparison With Untreated...

Area of Science:

• Surgical Innovation
• Pain Management
• Oncology

Background:

• Chronic postamputation pain, including residual limb pain (RLP) and phantom limb pain (PLP), causes significant long-term disability.
• The long-term efficacy of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) for pain management after limb loss is not well-established.

Purpose of the Study:

• To compare the long-term effectiveness of TMR and/or RPNI against no nerve reconstruction in oncologic amputees.
• To evaluate the impact of these nerve reconstruction techniques on chronic pain and controlled substance use.

Main Methods:

• A retrospective cohort study compared adult oncologic amputees who underwent TMR/RPNI with a historical cohort who did not receive nerve reconstruction.
• Outcomes, including pain scores (Numeric Pain Scale, PROMIS) and controlled substance use (opioids, benzodiazepines, pregabalin, gabapentin), were assessed at least 10 months post-amputation.

Main Results:

• The TMR/RPNI cohort showed significantly lower long-term RLP and PLP scores compared to the untreated cohort.
• Patients receiving TMR/RPNI reported lower PROMIS Pain Intensity and Behavior scores.
• Opioid and benzodiazepine/pregabalin use decreased significantly in the TMR/RPNI group, with a notable increase in gabapentin use, indicating a shift towards non-opioid analgesia.

Conclusions:

• Nerve reconstruction with TMR/RPNI provides durable, long-term reductions in chronic pain and opioid dependence in oncologic amputees.
• Physiologic nerve reconstruction offers sustained benefits, supporting improved survivorship and safer analgesic practices in amputation care.