Surgery
Preventing phantom limb pain
Patients who have undergone limb amputations will no longer have to suffer with chronic and debilitating pain, thanks to an early intervention surgical technique that takes just 15 minutes and requires no specialist equipment.
In research presented at the annual British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) Scientific Meeting in Belfast, Consultant Plastic Surgeon, Craig Nightingale, highlighted how a surgical technique can improve outcomes in patients undergoing limb amputation. He revealed how targeted muscle reinnervation (TMR), which is usually only carried out after the patient has suffered with chronic pain for months or years, can be carried out at the time of the amputation, taking just minutes. Following amputation, the nerves that used
to go into the limb are cut but still alive, sending signals that have nowhere to go. This can cause phantom limb pain, as well as burning, cramping and shooting sensations, often affecting work, social life, sleep and meaning the patient has to take pain medication. However, TMR, crucially done at the time of the amputation, connects the cut nerve to a smaller unused nerve that goes into a nearby muscle. This sends the nerve signals into a muscle instead of misfiring. With 85% of people who undergo limb amputation reporting chronic pain and/ or phantom limb pain, which can be severe and life-limiting, this procedure gives them a greater chance of returning to work sooner, living independently without requiring pain medication, and allows them the time to get used to wearing a prosthesis without the burden of chronic pain.
When carried out as a secondary procedure, TMR can take 60-90 minutes, incurring the costs of a new hospital admission, wound care, physiotherapy and pain medication. However,
when carried out at the time of the original surgery, it takes just 15 minutes and avoids the costs associated with a secondary admission. In an article titled: ‘PROCESS-guided case
series of primary targeted muscle reinnervation and regenerative peripheral nerve interfaces in the prevention of post-amputation and phantom limb pain’,1
Mr. Nightingale, says: “Chronic pain
and/or phantom limb pain in patients who have undergone amputations is typically treated months or even years following amputation. This means that patients can be in severe and chronic pain for such a length of time that it becomes a major clinical, psychosocial and even economic burden. “There is no singular treatment that is universally accepted as definitive, and we are
‘Performing targeted muscle reinnervation or regenerative peripheral nerve interface during the initial operation only takes a few minutes, but can make a very real difference for patients in
terms of quality of life and wellbeing.’ Craig Nightingale, Consultant Plastic Surgeon.
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www.clinicalservicesjournal.com I May 2026
keen to undertake larger randomised controlled trials to ascertain exactly how much of a change this procedure can make to so many lives, as well as to guide wider adoption of the technique.” Patients involved in the study – all of whom underwent TMR and/or another procedure called regenerative peripheral nerve interfaces (RPNI) at the time of the initial operation instead of months or years later – were followed up a year after surgery. Using a pain reporting scale that measures not only the level of pain but also the impact of pain on daily life, patients reported significantly lower pain scores compared with patients who did not receive the procedure(s). Mr. Nightingale concludes: “This isn’t just about pain scores. Chronic phantom limb pain affects whether someone can wear a prosthesis, leave the house, return to work, or live independently. Performing TMR or RPNI during the initial operation only takes a few minutes, but can make a very real difference for patients in terms of quality of life and wellbeing.” Consultant plastic surgeon and President of
BAPRAS, Paul McArthur, adds: “The TMR surgical technique at the time of amputation has shown to be an efficient way of preventing phantom
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