Targeted Muscle Reinnervation (TMR)

While a number of therapies exist to manage post-amputation pain, Targeted Muscle Reinnervation (TMR) is a surgical treatment that is gaining acceptance for nerve pain associated with amputation. In TMR, painful conditions may resolve 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.”

TMR was pioneered in 2002 by Dr. Todd Kuiken and Dr. Gregory Dumanian at Northwestern University. The procedure was originally developed to help amputees control their upper limb prosthetics using natural muscle movement. Throughout their research, Drs. Kuiken and Dumanian observed an additional, unexpected benefit of TMR surgery in amputees, namely reduced neuroma and phantom limb pain.1

During a TMR procedure, surgeons reroute amputated nerves by attaching them to other nerves in nearby muscles. Recent studies2,3 have demonstrated that patients who underwent TMR surgeries experienced less pain than patients who received standard treatments for amputated nerves.

Time of Amputation
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 research3 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.

Post Amputation
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.2 If you have already had an amputation and have developed phantom or neuroma pain, you may also benefit from TMR.

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Is TMR Right For Me?

Is TMR right for Me?