Amputations/Pain

What is Amputation Pain?

People who have had an amputation may experience pain in the remaining limb or phantom limb pain. This pain can feel like its coming from the amputated limb, and can range from mild to severe. It can feel like burning, shooting, pins and needles, twisting, crushing, or an electric shock. The pain often feels like its located in the part of the body thats farthest from the healthy body. For example, after a leg amputation, the foot may feel phantom pain.
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What is TMR (Targeted Muscle Reinnervation)

This is a procedure performed in patients undergoing limb amputation or in patients with painful neuromas after nerve injury. when a nerve is severed or injured, it attempts to regenerate. If the nerve does not have a clear target to regenerate toward, this process can result in a disorganized mass of nerve tissue called a neuroma.

TMR involves rerouting severed or injured nerves to new muscle targets using microsurgical techniques to provide the nerve endings with a new muscle to innervate.

TMR can help with:

Pain:

TMR can help with pain from neuromas, which are disorganized masses of nerve tissue that can cause a burning, aching, or electric shock.

Phantom Limb Pain

TMR can help with phantom limb pain, which occurs when the brain misinterprets information and continues to signal a missing limb.

Prosthetic Control

TMR can help improve the control of prosthetics by increasing muscle activity

The cause of amputation pain isn't fully understood, but it may be related to the remaining nerve connections in the brain and spinal cord "remembering" the amputated body part. Up to 80% of people who have an amputation experience phantom limb pain.

Recovery of TMR surgery

Recovering from TMR surgery is a multi- step process, that involves healing, physical therapy, and working with a prosthetist. The phantom pain and neuroma pain symptoms should continue to improve for three to six months after surgery.

Prosthetic fitting:
If TMR was performed at the time of amputation, patients can usually start fitting for a prosthetic six to eight weeks after surgery

Returning to work:
Patients who had TMR for established nerve pain may be able to return to work as early as three weeks after surgery, depending on their job

Normal Activities:
People can resume normal activities, including wearing a prosthetic, four to six weeks after surgery.
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Steps after TMR

A physical therapist will work with you on muscle strength, flexibility, and coordination, and trains you in how to use your prosthesis if one is part of your recovery. A prosthetist, or orthotic expert, will create a customized prosthesis if one will be used. An occupational therapist will also work with you to maximize your independence and adapt to daily life, with or without a prosthetic.

TMR Surgery

TMR surgery is most beneficial at time of amputation, however it can also be performed years later. This procedure is always performed under general anesthesia. The surgeon will reroute the severed nerves to nearby muscles to help reduce pain and problems with prosthetic use. The surgery generally takes around 2-4 hours, and requires a hospital stay of 1-5 days following procedure.