A new solution for reducing pain from amputated limbs

Nerve endings from amputated limbs can cause excruciating pain for years. We've pioneered a solution.

Nearly 75 percent of people who have lost an arm or leg from trauma, cancer or poor circulation will eventually suffer from debilitating pain.

Doctors at The Ohio State University Wexner Medical Center and College of Medicine have pioneered the use of primary targeted muscle reinnervation (TMR) for pain prevention. The procedure reroutes the nerves cut during amputation into motor nerves in nearby muscle.

Ian Valerio, MD, division chief of Burn, Wound and Trauma in Ohio State's Department of Plastic and Reconstructive Surgery, recently worked with former Ohio State resident J. Byers Bowen, MD, to publish instructions for this method and to document the technique's ability to prevent pain.

"A significant amount of pain in amputees is caused by disorganized nerve endings, called symptomatic neuromas, in the residual limb," says Valerio, who gained expertise as a military surgeon, treating wounded warriors with limb loss.

"Think of it like a live wire – if you cut a live wire, you have electrical shocks continuing to go through the severed wire. Neuromas form when nerves are severed and not addressed, thus the signals have nowhere to go."

Attaching those cut nerve endings to motor nerves in nearby muscle lets the body re-establish its neural circuitry and avoid the burning pain of neuromas as well as residual limb pain and/or phantom limb pain.

The surgeons performed 22 TMR surgeries in below-the-knee amputations over the course of three years and found that none of those patients developed symptomatic neuromas. Six months after surgery, just 13 percent of the patients reported any pain at all.

"TMR alleviates phantom and residual limb pain by giving those severed nerves somewhere to go and something to do," Valerio says.

“Nearly 75 percent of people who have lost an arm or leg from trauma, cancer or poor circulation will eventually suffer from debilitating pain.” Click to tweet this story

Groundbreaking research to reduce pain medicine dependency

The reduction in pain means that patients potentially will experience reduced dependence on pain medication over time, and they may be able to wear a prosthetic limb more effectively.

TMR surgery also is able to help those with upper-extremity amputations improve control of their prosthetics. The surgery allows for more individual muscle unit firings, so these patients can make more refined movements and have a greater range of motion.

Because of their groundbreaking findings, Ohio State researchers believe primary TMR is a reliable technique for preventing pain in all types of amputations.

If performed at the time of the initial amputation, patients have minimal health risks, and their recovery is similar to that of traditional amputation surgery. TMR can also be performed years after amputation to reduce pain and improve quality of life.

The research lays out a blueprint for surgeons to provide more successful outcomes and greater quality of life for patients following amputation.

Ohio State currently performs TMR routinely, with primary TMR being the standard of care for most traumatic and oncologic amputations. Valerio travels the world training surgeons on the technique to help ensure that amputees everywhere experience its benefits.

Ohio State's commitment to pioneering life-changing biomedical discoveries is driving treatment advancements across Ohio and in hospitals around the globe.

Learn more about TMR

Ian Valerio, MD, explains phantom limb pain and how Ohio State researchers are reducing nerve pain for amputees.

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