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Psychosocial Outcomes Following Targeted Muscle Reinnervation in Patients with Neuropathic Pain
Floris V. Raasveld, MD
1, Tsong-Hann Yu, MD
2, Ho Jim, BSc
2, Barbara Gomez-Eslava, MD, MS
1, Maximilian Mayrhofer-Schmid, MD
3, Woolf Clifford, MB, BSc, PhD
4, William Renthal, MD, PhD
5, David Hao, MD
2, Ian L Valerio, MD, MS, MBA
6; Kyle R. Eberlin, MD
6(1)Massachusetts General Hospital/Harvard Medical School, Boston, MA, (2)Massachusetts General Hospital/ Harvard Medical School, Boston, MA, (3)BG Klinikum Unfallkrankenhaus Berlin, Berlin, Berlin, Germany, (4)Boston Children's Hospital, Boston, MA, (5)Brigham and Women's Hospital/Harvard Medical School, Boston, MA, (6)Massachusetts General Hospital | Harvard Medical School, Boston, MA
Objective: Neuropathic pain significantly impacts quality of life (QoL), mental health, and function. Targeted Muscle Reinnervation (TMR) is an intervention that can effectively treat and prevent neuropathic pain, but its effects on psychosocial outcomes remain underexplored. This study evaluates psychosocial outcomes following TMR surgery for neuropathic pain in both amputees (both primary pTMR and secondary sTMR) and non-amputees.
Methods: In this prospective study, 46 patients (15 sTMR, 19 pTMR, 12 non-amputees) who underwent TMR for neuropathic pain management were assessed for psychosocial outcomes. Pre- and post-operative surveys measured pain catastrophizing (PROMIS), depression (PHQ-2), anxiety (GAD-2), sleep metrics (PROMIS Sleep Disturbance, sleep duration), and QoL (WHOQOL-2). Mean follow-up was 1.5±0.8 years.
Results: Pain catastrophizing significantly decreased across all groups (overall from 50.39±6.24 to 42.41±4.40, p<0.001). Depression and Anxiety scores improved significantly in the non-amputee and pTMR groups, but not in sTMR patients. Sleep disturbance decreased significantly in all groups (from 59.67±8.64 to 51.82±8.01, p<0.001), while sleep duration increased (from 5.32±1.63 to 6.09±1.29 hours, p<0.001). QoL scores improved significantly across all groups (from 2.45±0.87 to 3.43±0.62, p<0.001). Patients with psychiatric comorbidities (60.9%) showed similar improvements, despite having higher pre- and post-operative depression and anxiety scores.
Conclusions: Patients who underwent TMR for neuropathic pain management demonstrated improved psychosocial outcomes. Non-amputees and pTMR patients demonstrated greater improvements in depression and anxiety compared to sTMR patients. Sleep quality and duration improved substantially, a previously underreported benefit of TMR. Future, larger prospective studies should further validate relationship between neuropathic pain reduction through TMR and psychosocial outcomes.
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