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J Reconstr Microsurg 2025; 41(06): 459-468
DOI: 10.1055/a-2404-7732
Original Article

Early Postoperative Pain Course following Primary and Secondary Targeted Muscle Reinnervation: A Temporal Description of Pain Outcomes

Floris V. Raasveld
1   Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
3   Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Yannick Albert J. Hoftiezer
1   Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
4   Department of Plastic, Reconstructive and Hand Surgery, Radboudumc, Nijmegen, The Netherlands
,
Barbara Gomez-Eslava
5   Department of Neurobiology, F.M. Kirby Neurobiology Center, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
,
Justin McCarty
3   Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Ian L. Valerio
3   Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Marilyn Heng
6   Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Kyle R. Eberlin
3   Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract

Background Targeted muscle reinnervation (TMR) is an effective surgical treatment of neuropathic pain for amputees. However, limited data exist regarding the early postoperative pain course for patients who undergo either primary (<14 days since amputation) or secondary (≥14 days) TMR. This study aims to outline the postoperative pain course for primary and secondary TMR during the first 6 postoperative months to aid in patient education and expectation management.

Methods Patients were eligible if they underwent TMR surgery between 2017 and 2023. Prospectively collected patient-reported outcome measures of pain scores, Pain Interference, and Pain Intensity were analyzed. Multilevel mixed-effects models were utilized to visualize and compare pain courses between primary and secondary TMR patients.

Results A total of 203 amputees were included, with 40.9% being primary and 59.1% being secondary TMR patients. Primary TMR patients reported significantly lower pain scores over the full 6-month postoperative trajectory (p < 0.001) compared with secondary TMR patients, with a difference of Δ −1.0 at the day of TMR (primary = 4.5, secondary = 5.5), and a difference of Δ −1.4 at the 6-month mark (primary = 3.6, secondary = 5.0). Primary TMR patients also reported significantly lower Pain Interference (p < 0.001) and Pain Intensity scores (p < 0.001) over the complete trajectory of their care.

Conclusion Primary TMR patients report lower pain during the first 6 months postoperatively compared with secondary TMR patients. This may reflect how pre-existing neuropathic pain is more challenging to mitigate through peripheral nerve surgery. The current trends may assist in both understanding the postoperative pain course and managing patient expectations following TMR.

Level of Evidence Therapeutic – IV.

Keywords

targeted muscle reinnervation - neuroma - amputees - PROMs

Funding

This work was in part supported by the Jesse B. Jupiter/Wyss Medical Foundation Endowment. I. L. V. is a consultant for AxoGen Inc, Checkpoint Surgical Inc, and Integra Lifesciences Inc. K. R. E. is a consultant for AxoGen Inc, Checkpoint Surgical Inc, Integra Lifesciences Inc, Tissium, Tulavi Therapeutics Inc, and Biocircuit. F. V. R., Y. A. J. H., B.G.-E., J. M., and M. H. have nothing to disclose.




Publication History

Received: 13 March 2024

Accepted: 12 August 2024

Accepted Manuscript online:
27 August 2024

Article published online:
07 October 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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