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26/3/15
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INNOVATION FOR INDEPENDENCE
ISSUE 102 APRIL/MAY 2015 £6.95
New research to tackle limb pain after amputation By Nicola Hyde A TRIAL is underway to evaluate a surgical method that could help treat chronic pain following on from limb amputation. Northwestern Medicine researchers are leading a new multi-centre clinical trial into targeted muscle reinnervation. Around a quarter of all amputees develop chronic pain in the remaining portion of their amputated limb, which can include phantom limb syndrome (pain that is perceived in the portion of the limb that is gone), and prevents many patients from using prostheses. Northwestern Medicine’s chief of plastic surgery and principal investigator for the study, Gregory A. Dumanian, MD, said: “The problem for amputees that experience chronic pain isn’t that the limb itself was removed. The problem is that the nerves used to control the amputated limb are incomplete, but also remain active, constantly sending signals to the brain. “These separated nerves cannot heal properly without the chance to connect to other nerve tissue, and end up creating painful growths called neuromas.” The current standard of care for a painful amputee neuroma is to remove the nerve growth and then place the nerve ending
into a nearby muscle for extra cushioning. While this treatment can reduce neuroma pain, it is not always successful and still leaves the nerve active and disconnected to inevitably create a new neuroma. The TMR therapy’s goal is to transfer a nerve that has been cut-off from the muscles it used to control and essentially plug it into a functioning muscle nearby. This is accomplished by removing the neuroma from the damaged nerve, and then surgically joining it with a healthy nerve that controls the existing target muscle. Joining these nerves together allows them to then grow into, or reinnervate, the target muscle and prevent the neuroma from reforming. “TMR is a completely new approach to treating neuroma induced pain for amputees,” said co-investigator Todd Kuiken, MD, PhD, a Northwestern Medicine physiatrist who is director of the Centre for Bionic Medicine at the Rehabilitation Institute of Chicago and professor of surgery at the Northwestern University Feinberg School of Medicine. “Instead of trying to treat a painful neuroma by burying it, this procedure provides damaged nerves with a new purpose.”
Fashion is being injected into the functional by a Canadian company who have designed a line of accessories that fits onto prosthetic limbs. The Alleles Design Studio – founded by McCauley Wanner (industrial designer) and Ryan Palibroda (art/architecture) – was founded at the end of 2013 to create a fresh approach for designing for those with a disability. A company spokesman said: “By taking a fashion approach to the prosthetic industry we have designed a new line of prosthetic accessories which has transformed prosthetics into a new stream of fashion and have shifted prosthetics into objects of healthy curiosity. The covers are designed in 3D on a computer before being fabricated by CNC – a process that uses a computer-controlled cutting machine.”