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Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00029
10.1097/01.GOX.0001063924.32684.13
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
Predictive Value of Pre-operative Pain Sketches in Lower Extremity Amputees Undergoing Secondary Targeted Muscle Reinnervation for Treatment of Neuropathic Pain
Raasveld Floris MD 1
Hao David MD 1
Gomez-Eslava Barbara MD, MMSc 1
Hwang Charles 1
Valerio Ian MD, MS, MBA, FACS 1
Eberlin Kyle MD 1
Massachusetts General Hospital/ Harvard Medical School Boston, MA
9 2024
18 9 2024
12 Suppl 22Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcINTRODUCTION: Targeted Muscle Reinnervation (TMR) is an effective surgical treatment for neuropathic pain in amputees. (1) Qualitative descriptions of pain could enhance the understanding of symptomatic improvement following surgery. (2) Pain sketches can be used to depict this, and have been used in various neuropathic pain conditions, including amputees who underwent prophylactic TMR at time of amputation. (3-4) Our aim is to assess whether pre-operative pain sketches, drawn by lower extremity (LE) amputees, can predict surgical outcomes following Secondary TMR surgery in amputees with preexisting neuropathic pain.

METHODS: Eligible patients were LE amputees who underwent Secondary TMR surgery between 2017 and 2023. Pain sketches and pain scores were prospectively collected both before and after surgery. Pain progression, as categorized by pre-operative pain sketches, was analyzed and assessed for improvement, defined as reaching the Minimal Clinically Important Difference (MCID). (5) The transition to different pain sketches and the occurrence of phantom drawings were evaluated for their association with improvement.

RESULTS: Fifty-eight patients were included, of which 18 (31.1%) depicted diffuse pain (DP), 26 (44.8%) depicted focal pain (FP) and 18 (24.1%) depicted radiating pain (RP) in their pre-operative sketch. FP sketches were associated with the lowest pre- (p=0.002) and post-operative (p=0.045) pain scores and most frequently progressed to sketches indicating “no pain” (p=0.007). RP sketches were associated with the least pain improvement, the lowest likelihood of achieving the MCID, and were more prevalent in patients with diabetes or depression (p<0.050). RP sketches were associated with phantom drawings (p<0.001); no other sketch types progressed into RP sketches at the final follow-up.

SUMMARY: - In LE amputees who underwent Secondary TMR, pre-operative pain sketches may predict pain progression.

- FP sketches were associated with the most improvement. These may specifically reflect pain related to symptomatic neuromas, which could be more responsive to surgical intervention than pain that is more diffuse or even centralized.

- RP sketches were associated with worse outcomes, which may indicate the activation of different central neuronal pathways, distinct from those involved in neuroma pain or phantom limb pain alone.

REFERENCES:

1. Mioton LM, Dumanian GA, Shah N, et al. Targeted Muscle Reinnervation Improves Residual Limb Pain, Phantom Limb Pain, and Limb Function: A Prospective Study of 33 Major Limb Amputees. Clin Orthop Relat Res. 2020;478(9):2161-2167.

2. Hill EJR, Patterson JMM, Yee A, Crock LW, Mackinnon SE. What is Operative? Conceptualizing Neuralgia: Neuroma, Compression Neuropathy, Painful Hyperalgesia, and Phantom Nerve Pain. J Hand Surg Glob Online. 2023;5(1):126-132.

3. Gfrerer L, Hansdorfer MA, Ortiz R, et al. Patient Pain Sketches Can Predict Surgical Outcomes in Trigger-Site Deactivation Surgery for Headaches. Plast Reconstr Surg. 2020;146(4):863-871

4. Gomez-Eslava B, Raasveld F V, Hoftiezer YA, et al. Pain Sketches Demonstrate Patterns of Pain Distribution and Pain Progression following Primary Targeted Muscle Reinnervation in Amputees. Plast Reconstr Surg. Published online May 26, 2023:online ahead of print.

5. Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149-158.
