Novel Approaches to Reduce Symptomatic Neuroma Pain After Limb Amputation
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AMPUTATION REHABILITATION (J HECKMAN, SECTION EDITOR)
Novel Approaches to Reduce Symptomatic Neuroma Pain After Limb Amputation Sarah E. Hart 1 & Theodore A. Kung 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review A considerable number of major limb amputation patients will develop symptomatic neuromas within the residual limb. There has been a paradigm shift in the surgical treatment of symptomatic neuromas from techniques that attempt to interrupt axonal regeneration in favor of techniques that permit reinnervation. In addition, growing evidence suggests that successful treatment of peripheral nerve pain may diminish the development of phantom limb pain. We discuss novel surgical techniques that seek to prevent neuroma formation and in turn reduce phantom limb pain. Recent Findings Targeted muscle reinnervation and regenerative peripheral nerve interface surgery provide regenerating peripheral nerves denervated targets for reinnervation thus reducing the number of free axons available to form neuromas. While very different in technique, both approaches decrease the formation of symptomatic neuromas. In doing so, these methods reduce the experience of residual limb pain and phantom limb pain. Summary Implementation of innovative surgical techniques after peripheral nerve transection can transform the management of postamputation pain. Decreasing the impact of neuroma pain and phantom limb pain will facilitate prosthetic rehabilitation, decrease analgesic use, and improve quality of life after limb amputation. Keywords Postamputation pain . Residual limb pain . Neuroma . Phantom limb pain . Targeted muscle reinnervation . Regenerative peripheral nerve interface . Reinnervation
Introduction Approximately 2 million people in the USA are currently living with loss of an extremity and this number is projected to rise to 3.6 million by 2050 [1]. Major limb amputations are performed for multiple reasons including vascular disease related to diabetes or peripheral vascular occlusive disease (54%), trauma (45%), and cancer (< 2%) [2]. Postamputation pain develops in more than half of patients and is cited as one of the reasons why up to 30% of amputees go on to abandon their prosthesis [3–6]. Pain can lead to loss of function of the extremity and substantial physical disability [7–9]. Consequently, this leads to decreased productivity resulting in high rates of unemployment This article is part of the Topical Collection on Amputation Rehabilitation * Theodore A. Kung [email protected] 1
Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, 1500 E Medical Center Drive, 2130 Taubman Center, Ann Arbor, MI 48109, USA
with patients requiring workers’ compensation benefits [10, 11]. Patients with postamputation pain also experience decreased quality of life and psychosocial distress [12]. The reliance on daily opioids, neuropathic medications, and antidepressants is high and often provides suboptimal pain relief, adverse side effects, an
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