Interventional procedure overview of targeted muscle reinnervation for managing limb amputation pain

Indications and current treatment

A limb may need to be amputated for a variety of reasons, including peripheral vascular disease, infection, trauma, and cancer. When the limb is amputated, nerves at the end of the residual limb are cut. This can cause 2 types of persisting pain: residual limb pain (often resulting from nerve endings forming painful neuromas), or phantom limb pain sensed in the removed part of the limb. Pain can persist for many years after the amputation. It can have a substantial effect on quality of life and its management can be challenging.

Medicines that may be used to help relieve persisting limb pain after amputation include non-steroidal anti-inflammatory drugs such as ibuprofen, antiepileptics such as pregabalin or gabapentin, antidepressants that are used to treat nerve pain such as amitriptyline or nortriptyline, opioids such as codeine or morphine, corticosteroid or local anaesthetic injections.

Surgical options for treating a painful neuroma include removal of the damaged nervous tissue (neurolysis), transposition of the neuroma away from the exposed painful region into a suitable tissue, and repair and reconstruction of the damaged nerve to make the nerve fibres regenerate into the distal nerve end with the possibility to regain function.