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Comparative Long-term Pain Outcomes After Primary And Secondary Targeted Muscle Reinnervation
Maximilian Mayrhofer-Schmid, MD1, Floris V. Raasveld, MD
1, Otis van Varsseveld, MD
1, Benjamin R. Johnston, MD PhD
1, Anna Luan, MD MS
2, David Hao, MD
1, Ian L. Valerio, MD MS MBA
1, Kyle R. Eberlin, MD
1.
1Massachusetts General Hospital, Boston, MA, USA,
2Stanford University, Palo Alto, CA, USA.
PURPOSE:Targeted muscle reinnervation (TMR) is an established technique for neuropathic pain management in amputees, yet comparative long-term data between primary (prophylactic) and secondary (therapeutic) procedures remain limited. This study compared pain trajectories and time to pain relief between both approaches.
METHODS:A prospective longitudinal analysis was conducted on amputee patients with ≥12 months of follow-up. Primary TMR (pTMR) was performed within 14 days of amputation and secondary TMR (sTMR) thereafter. Pain trajectories were modeled using multilevel mixed-effects regression with natural splines. Pain mitigation was defined as sustained pain ≤3/10 for ≥3 months or, for sTMR, a ≥3-point reduction from the preoperative pain level.
RESULTS:The study included 204 patients (101 pTMR, 103 sTMR) with a median follow-up of 2.6 years (IQR 2.1-3.2). Long-term pain mitigation rates were comparable (66 % vs. 69 %, p = 0.681). Median time to pain relief was shorter after pTMR (5.4 vs. 12.9 months, p < 0.001). At 6 months, pTMR patients had 3.1-fold higher odds of sustained relief (95 % CI: 1.6-6.2, p < 0.001). Pain scores favored pTMR through 18 months; no differences persisted thereafter.
CONCLUSION:Primary TMR achieved earlier pain relief, while long-term outcomes were similar. These data support prophylactic TMR when feasible and confirm the therapeutic efficacy of delayed intervention.
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