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Page 6 of 10 Di Valerio et al. Plast Aesthet Res 2022;9:62 https://dx.doi.org/10.20517/2347-9264.2022.50

Table 3. PROMIS analysis - pain intensity, behavior & interference
Pain intensity Pain behavior Pain interference Follow-up
Alexander, PLP 5.855 (95%CI 1.159, 5.896 (95%CI 0.492, 7.435 (95%CI 1.797, 13.07; > 1 year
[6]
2019 (mean 10.55; P = .015) 11.30; P = .033) P = .011)
differences)
RLP 5.477 (95%CI 0.528, 6.195 (95%CI 0.705, 6.816 (95%CI 1.438, 12.2; > 1 year
10.42; P = .031) 11.69; P = .028) P = .014)
(mean
differences)
Dumanian, PLP 11.7 (-0.3, 23.7) 1.1 (-8.3, 10.5) 4.7 (-5.0, 14.3) At 1 year
[7]
2019 (mean
differences)
9.3 (-1.4, 20.0) 4.3 (-4.7, 13.2) 4.7 (-5.6, 15.3) At last follow-up
RLP 5.8 (-0.9, 12.4) -0.5 (-7.2, 6.1) -0.9 (-8.5, 6.7) At 1 year
(mean
differences)
5.8 (-0.3, 11.2) -0.7 (-7.5, 6.1) 0.5 (-7.0, 8.1) At last follow-up
Valerio, PLP TMR 36.3 vs. control 48.3 TMR 50.1 vs. control 56.6 TMR 40.7 vs. control 55.8
2019 [20] (median t-
score)
RLP TMR 30.7 vs. control 46.8 TMR 36.7 vs. control 57.3 TMR 40.7 vs. control 57.3 Median 330 days (TMR
(median t- group)
score)
O’Brien, PLP 33.5 vs. control 46.8 50.1 vs. control 53.1 40.7 vs. control 50 Average 23.1 months (for
2021 [21] (median t- P = < .05 P = < .05 P = < .05 TMR group)
score)
RLP 33.5 vs. control 46.8 36.7 vs. control 53.1 40.7 vs. control 48.2
(median t- P = < .05 P = < .05 P = .146
score)

PLP: Phantom limb pain; RLP: residual limb pain; TMR: targeted muscle reinnervation.

Table 4. Subjective patient outcomes
First author, Type of study Nerve transfer Outcome
year
[15]
Janes, 2020 Case series Lower extremity (17)
● Primary treatment for Primary treatment 7 total follow-up patients: 5 reported resolution of
neuroma pain (10) symptoms, 2 reported improvement in pain
● Secondary treatment (7) Secondary treatment: all denied development of neuroma pain
Kubiak, 2019 [16] Retrospective Primary treatment 0 patients in treatment group developed symptomatic neuroma vs. 13.3%
cohort Upper extremity (10) of control
Lower extremity (80) 51.1% of TMR patients developed PLP vs. 91.1%
Morgan, Case series Upper extremity (5) All patients reported improvements in pain symptoms
2016 [17] ● Primary treatment for
neuroma pain (3)
● Secondary treatment (2)
Pet, 2014 [18] Retrospective Upper extremity (19) 92% of primary TMR treatment neuroma free. 50% developed PLP
review ● Primary treatment (11) 87% of secondary TMR treatment neuroma free. Equivocal findings
● Secondary treatment (8) regarding PLP
Lower extremity (16)
● Primary treatment (1)
● Secondary treatment (15)
[19]
Souza, 2014 Retrospective Secondary treatment 93% of patients with existing neuroma pain experienced resolution of
Review Upper extremity (26) symptoms
TMR: Total muscle reinnervation; PLP: phantom limb pain; avg: average.

DISCUSSION
This systematic review of currently available literature supports the use of TMR to minimize PLP and
residual limb pain (RLP) after upper and lower extremity amputation. Included studies demonstrated