The Wexner Medical Center at Ohio State and the College of Medicine have partnered to research a new solution for phantom limb pain in amputee patients.
Phantom pain is the perception of pain or feeling in a missing limb after amputation, and is relatively common after patients lose an appendage. It is unknown by researchers if the effect stems from the nervous system or is psychological. In order to improve patient care, the study focuses on stopping phantom pains before they begin.
Dr. Ian Valerio, chief of the Division of Burn, Wound and Trauma at the medical center, has been involved with regenerative targeted muscle reinnervation techniques (TMR) since he was in the military. He works with cancer, trauma and congenital amputee patients to treat the disorganized nerve receptors that cause these sensations.
Since new developments are always being made, implementing techniques like these are still considered to be groundbreaking, Valerio said.
“Right now, it’s not a standard of care, but we think it should be at some point, and that’s what we’re trying to do is educate people on how to do this technique,” he said.
Valerio said the medical center is one of the few centers that use TMR, noting that it’s use of the technique has made it a leader in the industry in terms of the number of cases it has treated.
TMR surgery involves redirecting damaged nerve endings responsible for movement to other parts of the muscle. While previously used only to improve prosthetic control, it was discovered that it helps curb residual pain as well, according to Valerio.
“When I came to Ohio State back in 2014, I brought [TMR] here and adopted it as a way to treat amputees, rather than wait until long after their amputations to address phantom limb pain,” Valerio said.
While normal amputation leaves nerves behind after cutting them, often leading to pain or scarring, TMR allows nerves to regrow over time. After rehooking neural pathways to the brain, limbs send out new signals and are able to function again.
According to the most recent publication of the Journal of the American Society of Plastic Surgeons, about 95 percent of amputees end up feeling some form of phantom pain. However, more than 70 percent of primary TMR patients find themselves off pain medication soon after treatment.
“We’ve done well over a few hundred [surgeries] now, and with additional follow-up cases, it has been shown to significantly reduce pain in these patients, and it basically more than reduces the pain of over half of amputees that have had TMR,” Valerio said.
This research also helps to advance prosthetic technology and tolerance, while working toward the reduction of pain medication use and subsequent dependency.
Dr. K. Craig Kent, dean of the College of Medicine, said in a press release that Valerio’s research will play a vital role in the treatment of amputees.
“This paper provides a blueprint for improving patient outcomes and quality of life following amputation,” Kent said.