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Targeted muscle reinnervation can be used in the NHS while more evidence is generated to treat intractable pain that develops after limb amputation. It can only be used with special arrangements for clinical governance, consent, and audit or research.
Healthcare professionals wanting to do targeted muscle reinnervation to treat intractable pain that develops after limb amputation should:
Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
More research is needed on targeted muscle reinnervation before it can be used in the NHS to prevent intractable pain from developing after limb amputation.
This procedure should only be done as part of a formal research study and a research ethics committee needs to have approved its use.
What research is needed
More research, preferably randomised controlled trials, is needed on:
patient selection
details of the technique used
the need for reintervention
short- and long-term outcomes, including effects on pain and quality of life.
Why the committee made these recommendations
Evidence on this procedure shows it can reduce pain that develops after limb amputation and there are no major safety concerns. But, there is a lack of high-quality evidence. The evidence includes procedures that were done after amputation to treat pain and at the same time as amputation to prevent pain from developing.
Intractable pain is pain that does not go away, even with treatment. This can have a substantial impact on quality of life and there are few treatment options. So, this procedure can be used with special arrangements to treat intractable pain that develops after limb amputation.
It is unclear who would benefit from the procedure when it is used at the same time as amputation to prevent intractable pain from developing. More evidence is needed on patient selection before the procedure is used in this population.
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