Back to 2026 Abstracts
Comparative Trajectories Of Post-amputation Pain Relief: Tmr, Rpni, And Combined Techniques
Rami Elmorsi, MD, Ashley Shin, MD, David Adelman, MD, Alexander F. Mericli, MD, Margaret S. Roubaud, MD.
MD Anderson Cancer Centre, Houston, TX, USA.
Introduction: Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have demonstrated efficacy in addressing post-amputation pain, yet the variability in outcomes between techniques (TMR only, RPNI only, TMRPNI, and combinations) remains unknown.
Methods: Patients undergoing oncologic amputations between 2018-2024 completed the Numerical Rating Scale (NRS) for residual limb pain (RLP) and phantom limb pain (PLP), as well as PROMIS domains for pain intensity, interference, and behavior at multiple postoperative timepoints. Narcotic use was assessed via prescription drug monitoring programs. Correlation analyses evaluated associations between time from surgery and pain/medication outcomes.
Results: Only TMR-containing procedures demonstrated consistent associations with improvement over time. Significant reductions were observed in PROMIS Pain Intensity (TMR ρ=-0.29, p=0.03; TMRPNI ρ=-0.36, p<0.001; TMRpni+RPNI ρ=-0.31, p=0.02), Pain Interference (TMRpni ρ=-0.26, p=0.001), Pain Behavior (TMRpni ρ=-0.18, p=0.04), and narcotic use (TMR ρ=-0.41, p=2.6×10⁻⁴; TMRpni ρ=-0.32, p=6.1×10⁻⁵). Improvements in NRS-RLP and PLP were only observed in TMRpni+RPNI (both ρ=-0.34, p=0.03). At ≥9 months, NRS scores, PROMIS measures, and narcotic use were uniformly low across all groups with no significant differences (p>0.05), suggesting convergence of long-term outcomes.
Conclusion: Although long-term outcomes approximate across all reconstructive techniques, procedures incorporating TMR exhibit steeper trajectories of improvement, with stronger correlations to pain reduction and decreased opioid use, suggesting earlier benefit compared with RPNI alone.
Back to 2026 Abstracts
