Treating Phantom Limb Pain and Neuroma with TMR Surgery

Chronic pain impacts more than two million amputees in the United States. Chronic pain may either be isolated to the residual limb in the form of a neuroma or present as phantom limb pain in a limb that has been amputated. The chronic pain associated with these conditions can have a significant impact on a patient’s quality of life and functionality.

The phantom limb phenomenon consists of three elements:

  • Phantom limb pain: Painful sensations that are being experienced in the amputated limb;
  • Phantom limb sensation: Sensations other than pain that are being experienced in the amputated limb;
  • Stump pain: Pain localized to the amputated limb remains

Understanding Phantom Limb Pain

What is phantom limb pain?

Phantom limb pain is a complex pain syndrome that is described as burning, aching, or electric-type pain in the amputated limb. This pain often begins shortly after surgery. In some cases, phantom limb pain may gradually go away over time. However, for many patients, phantom limb pain becomes a chronic and debilitating condition. Inadequate control of preoperative and postoperative pain may increase the risk of chronic amputation pain. 

Though the limb has been amputated, nerves that once connected the brain to the amputated limb are still active and able to send pain signals to the brain.

How common is phantom limb pain?

Phantom limb pain is quite common, affecting about 60-85% of all amputees. Of those patients who do suffer with phantom limb pain, a majority will experience relief through treatments that mirror other neuropathic pain treatments: rehabilitation and ultimately, surgery.

What is the most effective treatment for phantom limb pain?

Treatment of phantom limb pain is approached in a manner similar to treatment of other conditions leading to chronic neuropathic pain. Advanced nerve surgery techniques can be used to provide long-term pain relief where non-invasive therapies have failed or ceased to be effective.

Understanding Neuroma Formation

What happens to nerves after amputation?

When a limb is amputated, one end of the nerves connecting that limb to the brain and central nervous system will be severed as well. In this process, damaged nerve fibers may metastasize into a mass which we call a Neuroma. This mass will send confusing signals to the brain and can cause mild to extreme pain.

What is a neuroma?

A neuroma is a disorganized growth of nerve cells at the site of a nerve injury. A neuroma occurs after a nerve is partially or completely disrupted by an injury — either due to a cut, a crush, or an excessive stretch. During limb amputation, the nerves are cut and one end is removed with the limb, preventing the nerve from repairing itself.

What are the symptoms of a neuroma?

Neuromas can be painful and can cause tingling sensations when tapped or when pressure is applied. Although not always the case, a neuroma can be extremely painful and can cause significant loss of function for the patient by limiting motion and contact with the affected area. This can also make wearing a prosthesis impossible.

Treatments for Phantom Limb Pain associated with Major Limb Amputations and Neuroma Formation

Neuroma Formation & Treatment

Prior treatments for neuromas and phantom limb pain have involved both surgery and medications, such as neuromodulators like gabapentin. Standard surgical intervention usually involves excision and burying of the nerve containing the neuroma.  However, the nerve that is buried can possibly form another neuroma.  Phantom limb pain is even harder to prevent or treat.

What is Targeted Muscle Reinnervation (TMR)?

Targeted Muscle Reinnervation (TMR) surgery involves the transfer of nerves that once controlled the amputated limb to reinnervate (restore function to) remaining muscles. Following surgery, nerves grow back into the new muscles, decreasing and potentially preventing misdirected nerve growth, which can contribute to pain within the residual limb. TMR has the potential to treat pain from neuromas while enabling amputee patients to return to their activities of daily living and improve prosthetic use and tolerance.

What does a TMR surgery include?

Targeted Muscle Reinnervation (TMR) surgery requires a graft of nerves from one area of the body to reinstate healthy (and less painful) nerve function inside the limb remains, partial limb, stump, or other connective tissue. This inpatient procedure is safe and recommended for individuals with chronic or consistent nerve pain.

How effective is TMR surgery?

Patients who experience chronic nerve pain often exhaust all other options before choosing surgery. However, once surgery is “on the table” as an option for patients, we answer every question and ensure complete confidence before we begin this course of treatment.

We Are The Best Amputee Pain Management Specialist in New Jersey

At The Institute for Advanced Reconstruction, we pride ourselves on being the ‘go to’ center for revolutionary nerve procedures with comprehensive surgeries and treatments for those suffering from phantom limb sensation or pain and neuromas after amputation. Our reconstructive surgeons in New Jersey perform the latest groundbreaking techniques to treat both stump neuromas and phantom limb pain. We perform a new treatment for phantom pain called Targeted Muscle Reinnervation (TMR). With TMR surgery you can return back to your daily activities without feeling ghost pain after amputation. 

Contact us today to learn more about our amputee pain management specialist and treatment options in New Jersey!

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