Understanding the procedure
TMR joins the end of a severed nerve to a suitable motor nerve branch supplying nearby muscle. It aims to provide a destination for regenerating nerve fibres. It may be considered after amputation for established pain; use at the time of amputation raises a separate question about prevention.
When might it be considered?
- Selected painful neuromas or residual limb pain after amputation.
- A specialist assessment of phantom limb pain alongside other causes of pain.
- An individualised discussion of nerve management when amputation is being considered.
Specialist assessment
The team assesses neuroma pain, socket-related pressure, skin and bone problems, nerve function and the availability of suitable targets. A multidisciplinary pain and rehabilitation assessment helps define what surgery can reasonably address.
Treatment & recovery
Surgery and rehabilitation are tailored to the anatomy and wider prosthetic plan. Improvement is not guaranteed, and persistent pain, wound problems, weakness or further surgery are possible. NICE guidance distinguishes treatment of established post-amputation pain from preventive use; the applicable evidence and clinical arrangements should be discussed during consultation.
Common questions
Is TMR suitable for every person with phantom limb pain?
No. Phantom pain has different mechanisms, and not all are addressed by surgery to peripheral nerves.
Can TMR prevent pain if performed during amputation?
Preventive use is distinct from treating established pain. NICE identifies a need for further research on primary prevention; suitability and the relevant arrangements need specialist discussion.
General patient information from London Nerve Injury. Decisions about investigations and treatment require an individual clinical assessment.