Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces Advance Pain Management in Limb Amputation: A Systematic Review and Meta-analysis
Larissa Tanimoto1, Andressa Cardoso2, Pedro Henrique De Souza Wagner3, Fernanda Tamashiro1, Helen Beckert4
1University of Buenos Aires, 2July nine University, 3Federal University of Santa Catarina, 4Federal University of Paraná
Objective:
This meta-analysis and systematic review evaluate the effectiveness of Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) versus standard treatment, focusing on pain reduction.
Background:
Pain management in amputees is challenging due to conditions like painful neuromas, phantom limb pain (PLP), and residual limb pain (RLP). Traditional interventions primarily relieve symptoms, while TMR and RPNI target the underlying causes of neuropathic pain, potentially improving outcomes.
Design/Methods:
A systematic search in the PubMed, Scopus, Cochrane, and Web of Science databases identified studies examining pain improvement in patients undergoing TMR and RPNI during limb amputation. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) are used for binary and continuous endpoints, respectively. Heterogeneity is evaluated using the I² statistic. Statistical analyses were performed with RStudio version 4.4.1.
Results:
Fourteen studies involving 1,227 patients were included. TMR demonstrated favorable outcomes compared to standard treatment. For PLP, TMR improved the PROMIS interference score (MD -7.782; 95% CI -14.140 to -1.424; P = 0.016; I² = 81%), behavior score (MD -8.557; 95% CI -11.629 to -5.485; P < 0.001; I² = 12%) and intensity score (MD -12.718; 95% CI -19.084 to -6.352; P < 0.001; I² = 86%). Significant enhancement was also observed for RLP (MD -8.633; 95% CI -9.882 to -7.384; P < 0.001; I² = 0%). The NRS Worst score indicated reduced pain for PLP (MD -2.142; 95% CI -2.860 to -1.423; P < 0.001; I² = 0%) and RLP (MD -1.873; 95% CI -3.075 to -0.670; P = 0.002; I² = 66%). RPNI also showed a favorable pain score compared to standard treatment (OR 0.04; 95% CI 0.01-0.21; P = 0.000184; I² = 0%).
Conclusions:
This meta-analysis demonstrates that TMR and RPNI significantly reduce PLP and RLP compared to standard treatment, enhancing pain management and functional recovery in amputee patients.
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