Abstract：
BACKGROUND: Targeted muscle reinnervation (TMR) has been shown to reduce phantom limb pain (PLP) and residual limb pain (RLP) after major limb amputation. However, the effect of the timing of surgery on pain control and quality of life outcomes is controversial. We conducted a retrospective study to compare the outcomes of acute TMR for pain prevention with non-acute TMR for the treatment of established pain.
METHODS: All patients treated with TMR in our institution between January 2018 and December 2021 were evaluated at 6, 12, 18 and 24 months post-operatively. Pain intensity and quality of life outcomes were assessed using the Brief Pain Inventory (Pain Severity and Pain Interference scales) and Pain Catastrophizing Scale. Outcomes were compared between acute and non-acute TMR using the Wilcoxon ranked-sum test or Fisher\'s exact test as appropriate. Multilevel mixed-effects linear regression was used to account for repeat measures and potential pain confounders.
RESULTS: Thirty-two patients with 38 major limb amputations were included. Acute TMR patients reported significantly lower RLP and PLP scores, pain interference and pain catastrophisation at all time points (p < 0.05). Acute TMR was significantly associated with lower pain severity and pain interference in a linear mixed-effects model accounting for patient age, gender, amputation indication, amputation site, time post-TMR and repeated surveys (p < 0.05). There was no significant difference in the complication rate (p = 0.51).
CONCLUSIONS: Acute TMR was associated with clinically and statistically significant pain outcomes that were better than that in non-acute TMR. This suggests that TMR should be performed with preventative intent, when possible, as part of a multidisciplinary approach to pain management, rather than deferred until the development of chronic pain.
METHODS: All patients treated with TMR in our institution between January 2018 and December 2021 were evaluated at 6, 12, 18 and 24 months post-operatively. Pain intensity and quality of life outcomes were assessed using the Brief Pain Inventory (Pain Severity and Pain Interference scales) and Pain Catastrophizing Scale. Outcomes were compared between acute and non-acute TMR using the Wilcoxon ranked-sum test or Fisher\'s exact test as appropriate. Multilevel mixed-effects linear regression was used to account for repeat measures and potential pain confounders.
RESULTS: Thirty-two patients with 38 major limb amputations were included. Acute TMR patients reported significantly lower RLP and PLP scores, pain interference and pain catastrophisation at all time points (p < 0.05). Acute TMR was significantly associated with lower pain severity and pain interference in a linear mixed-effects model accounting for patient age, gender, amputation indication, amputation site, time post-TMR and repeated surveys (p < 0.05). There was no significant difference in the complication rate (p = 0.51).
CONCLUSIONS: Acute TMR was associated with clinically and statistically significant pain outcomes that were better than that in non-acute TMR. This suggests that TMR should be performed with preventative intent, when possible, as part of a multidisciplinary approach to pain management, rather than deferred until the development of chronic pain.
摘要：
背景：有针对性的肌肉神经支配（TMR）已被证明可以减轻肢体截肢后的幻肢痛（PLP）和残肢痛（RLP）。然而,手术时机对疼痛控制和生活质量结局的影响存在争议.我们进行了一项回顾性研究，以比较急性TMR预防疼痛与非急性TMR治疗既定疼痛的结果。
方法：2018年1月至2021年12月在我们机构接受TMR治疗的所有患者均在术后6、12、18和24个月进行评估。使用简短疼痛量表（疼痛严重程度和疼痛干扰量表）和疼痛灾难量表评估疼痛强度和生活质量结果。在急性和非急性TMR之间使用Wilcoxon排名和检验或Fisher精确检验来比较结果。使用多级混合效应线性回归来解释重复测量和潜在的疼痛混杂因素。
结果：纳入了32例38例下肢截肢患者。急性TMR患者报告RLP和PLP评分明显较低，所有时间点的疼痛干扰和疼痛灾难(p<0.05)。在考虑患者年龄的线性混合效应模型中，急性TMR与较低的疼痛严重程度和疼痛干扰显着相关。性别,截肢适应症,截肢部位,TMR后时间和重复调查(p<0.05)。并发症发生率差异无统计学意义(p=0.51)。
结论：急性TMR与临床和统计学显著疼痛结局相关，优于非急性TMR。这表明TMR应出于预防目的进行，如果可能,作为疼痛管理多学科方法的一部分，而不是推迟到慢性疼痛的发展。
方法：2018年1月至2021年12月在我们机构接受TMR治疗的所有患者均在术后6、12、18和24个月进行评估。使用简短疼痛量表（疼痛严重程度和疼痛干扰量表）和疼痛灾难量表评估疼痛强度和生活质量结果。在急性和非急性TMR之间使用Wilcoxon排名和检验或Fisher精确检验来比较结果。使用多级混合效应线性回归来解释重复测量和潜在的疼痛混杂因素。
结果：纳入了32例38例下肢截肢患者。急性TMR患者报告RLP和PLP评分明显较低，所有时间点的疼痛干扰和疼痛灾难(p<0.05)。在考虑患者年龄的线性混合效应模型中，急性TMR与较低的疼痛严重程度和疼痛干扰显着相关。性别,截肢适应症,截肢部位,TMR后时间和重复调查(p<0.05)。并发症发生率差异无统计学意义(p=0.51)。
结论：急性TMR与临床和统计学显著疼痛结局相关，优于非急性TMR。这表明TMR应出于预防目的进行，如果可能,作为疼痛管理多学科方法的一部分，而不是推迟到慢性疼痛的发展。
