Your Shopping Cart

Stopping Phantom Limb Pain Before It Starts with Primary TMR

Posted by Bryan Potok, CPO on

Phantom limb pain used to be a mysterious condition and for a long time was poorly understood. In recent years, advances in medicine are changing that.  Early this year, a new theory about phantom limb pain shed light on what causes it. Dr. Max Ortiz Catalan, Associate Professor at the Chalmers University of Technology and head of the Biomechatronics and Neurorehabilitation Laboratory, published a paper on “stochastic entanglement,” describing how phantom limb pain is caused by entangled neural circuitry caused after an amputation. 

Amputee suffering from phantom limb pain, which could be stopped before it starts with primary TMR.

Running along the same vein, primary Targeted Muscle Reinnervation (TMR) seems to be the answer to stopping or mitigating the effects of phantom pain even before it starts. Pioneered by surgeons at The Ohio State University Wexner Medical Center, primary TMR entails the rerouting of nerves cut during amputation into surrounding muscle.

According to Dr. Ian Valerio, division chief of Burn, Wound, and Trauma at the Ohio State’s Department of Plastic and Reconstructive Surgery, the process of attaching the nerve endings to motor nerves in a nearby muscle allows the body to re-establish its neural circuitry. It gives the severed nerves something to do as opposed to being left alone to be entangled.

Primary TMR surgery was initially developed to allow upper limb amputees to control their prosthesis better. This was how surgeons discovered that the procedure could also improve specific causes of pain. Eventually, they began using primary TMR to treat disorganized nerve endings called symptomatic neuromas or phantom limb pain.   

In three years, surgeons at Ohio State performed 22 TMR surgeries—18 primary and four secondary—on below-the-knee (BK) amputees. None of the patients developed phantom limb pain. Only 13% of those who received primary TMR reported experiencing phantom pain six months after the surgery. Furthermore, those who underwent the procedure reportedly reduced or, in some cases, stopped the use of narcotics and other nerve-related pain medications.

Given the results, the researchers believe that when primary TMR is done at the time of initial amputation, there is a minimal health risk. Meanwhile, recovery is similar to that of traditional amputation surgery.

What do you think of this technique? It appears promising for sufferers of phantom limb pain. Share your thoughts with us in the comments section below.
Link to this page
<a href="">Stopping Phantom Limb Pain Before It Starts with Primary TMR</a>

Older Post Newer Post


  • I recently had a below the knee amputation in May with TMR. I have had phantom sensations and a few moments of phantom pain for only one month to a month and a half post surgery. I am five months post surgery and no phantom pain. The only discomfort I have is when my socket needs to be adjusted. I don’t even take acetaminophen or ibuprofen regularly. Ice is the only thing I use regularly.

    Cathy Hunt on

  • Do you have a pill/ medicine to treat phantom limb suffering from it

    Mario Dante de la Cruz on

  • I am a quadruple amputee; below elbow and below knee. My initial amputations were done at Ohio State prior to Dr. Valerio being on staff. Dr. Valerio performed the TMR surgery on one of my lower limbs post amputation due to a neuroma. I have had minimal discomfort or difficulty wearing my prosthesis since.

    Todd Hammond on

  • This treatment appears promising but doesn’t always go according to plan. There is a very clever plastic surgeon in the UK who is also performing this surgery on lower limb amputees. This was attempted in my case, but the muscle at the back of my stump was too damaged for this procedure to take place. At the time of my surgery I was quoted chances of some improvement of 60% as I have suffered from phantom pain for more than ten years. If you have this surgery you need to be prepared for a significant increase in pain initially. Six months later I am still taking substantially more opiate medication than I was before the surgery. In the immediate period following the operation I was taking opiate medication of more than double my previous dose. I don’t regret trying the surgery, but you need to do this with your eyes open and a plan for post-operative pain control. If you are in the UK and want more information, contact Mr Norbert Kang at the Royal Free Hospital.

    Mrs Rachael Vasmer on

  • Unless the pain is extremely severe, they will play-hell getting an amputee back under the knife voluntarily. Every waking moment is lived with protecting what’s left of the leg (or arm) so that more surgery is NOT required. I agree that it should be done at the time of the initial surgery, however.

    Terry Collins on

Leave a comment

Please note, comments must be approved before they are published


Sign up for Amputee News and Offers