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Factors Associated With Successful Pain Mitigation Following Primary And Secondary Targeted Muscle Reinnervation In Amputees
Floris V. Raasveld, MD1, Maximilian Mayrhofer-Schmid, N/A
2, Barbara Gomez-Eslava, MD, MMSc
3, Yannick A. Hoftiezer, MD
4, Kyle R. Eberlin, MD
1, Ian L. Valerio, MD, MS, MBA, FACS
1;
1Massachusetts General Hospital, Boston, MA, USA,
2University of Heidelberg, Heidelberg, Germany,
3Boston Children's Hospital, Boston, MA, USA,
4Radboud University, Nijmegen, Netherlands
PURPOSE: Targeted Muscle Reinnervation (TMR) is an effective modality in the surgical management of neuropathic pain for amputees. TMR can be performed primarily for prevention, or secondarily for treatment of neuropathic pain. However, the specific patient cohort for whom this technique is most effective is not known.
METHODS: Prospectively enrolled amputees who underwent TMR between 2018 through 2023, (minimum follow-up:6 months) were included. Demographic, surgery-related and pain data (NRS,0-
10)) were analyzed. Sustainable pain mitigation was defined as NRS of ≤3/10 for ≥3 months until last follow-up.
Multi
-level mixed-effects models were utilized to analyze postoperative pain courses.
RESULTS: 128
amputees were included (1.9 years follow-up (IQR:1.0-2.8)), of which 61 patients (47.7%) underwent Primary TMR Following primary TMR, 54.1% of patients achieved sustainable pain prophylaxis and demonstrated significantly lower pain scores (p<0.001), compared to other patients(Fig. 1). Following Secondary TMR, 50.1% of patients achieved sustainable pain remission and demonstrated significantly lower pain levels at 12-24 months postoperative (p<0.05) compared to other patients(Fig. 2). In primary TMR patients, pain prophylaxis was associated with absence of: depression, post-traumatic stress disorder and smoking (p<0.05). In secondary TMR patients, higher BMI, absence of psychiatric diseases and peripheral vascular disease were associated with pain remission (p<0.5).
CONCLUSION:Following TMR, pain improvement was observed for both primary and secondary TMR patients. Psychiatric comorbidities appear to be a risk factor for worse outcomes in both groups.
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