According to Cleveland Clinic, “An estimated 8 out of 10 people who lose a limb experience some degree of phantom pain.”

There are a number of therapies to manage post-amputation pain. Targeted Muscle Reinnervation (TMR) is a surgical treatment quickly gaining broad acceptance for nerve pain associated with amputation. In TMR, painful conditions may improve when amputated nerves are reconnected to nearby nerves and eventually muscle targets. If you think about nerves as electrical wiring, TMR helps to complete the “circuit” by reconnecting the “live wire.”

There are two instances where TMR surgery might be conducted. 

TMR at the time of amputation

The prevalence of post-amputation pain is high, with 74% of patients experiencing painful neuromas and 80% experiencing phantom limb pain following surgery. Some research suggests that TMR is most effective when performed preemptively before nerve pain begins. If you and your physician are planning an amputation, you may want to discuss TMR as an option.

TMR post-amputation

TMR is also performed to address pain that has developed from a prior amputation. TMR can be effective even in patients with established nerve pain – as long as 10 years following the initial amputation. 


Preparing for your first visit

As you are learning more about TMR surgery as an option, it’s helpful to have a checklist with you for your first visit. To ensure you start with a clear and open conversation with your surgeon, you should be ready to share as much detail as possible. For example: 

Details Regarding Your Amputation

If the doctor is unfamiliar with your case, you should be prepared to describe the circumstances of your amputation: When did it occur? Why was the amputation performed?

Your History with Post-Amputation Nerve Pain

If you are exploring TMR for pain relief, you should be prepared to describe your pain in detail: Is it phantom pain or residual limb (stump) pain? How severe is the pain? How often does it occur?

How You’ve Managed Your Pain to Date

You should be prepared to talk about all medications and treatments you’ve tried and how effective they were in alleviating your pain. Your doctor will want to understand the impact your pain has had on your life. Is your pain limiting the use of your prosthetic? Is it impacting your relationships, your physical activity or your ability to work?

Your Goals for Managing Your Pain

Your doctor will want to understand your personal goals for considering TMR for pain. Would you like to be able to use your prosthetic? Get off medications? Resume an active lifestyle? 

Specific questions once surgery is scheduled

The questions you have for your doctor will depend on your physical condition. But these are common questions to think about:

  1. How long will the surgery last? 
  2. Where will my incision be? 
  3. Will I have to stay in the hospital? 
  4. What will you do for pain management following surgery? 
  5. How often will I need to see you following surgery? 
  6. When will I be able to put my prosthesis back on? 
  7. When can I return to work following surgery? 
  8. When can I start driving again? 
  9. When will I begin to feel relief from nerve pain and phantoms?
  10. What if the surgery does not work?

Starting the process of researching TMR nerve surgery should be a positive experience. The trauma of limb loss is the worst hurdle, and one that likely you are addressing through a network of providers, support systems and family. This next step of choosing a potentially life-altering surgery is a matter of investigation and preparation. 

For a list of surgeons who perform TMR nerve surgery, view our physicians list. 


Written by Staff

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