Grant: Planning and Dissemination Grant - Institute Community Support

For the limb loss community, neuromas (painful nerve overgrowth) and phantom limb pain (PLP) are common and highly problematic conditions that negatively affect well-being. People with these conditions often cannot tolerate wearing their prostheses, which reduces their independence and ability to participate in their communities. Recent surgical advances, including novel approaches such as Targeted Muscle Re-innervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) surgeries, have shown to be highly effective in addressing painful neuromas and PLP. Although there is evidence supporting their clinical efficacy for reducing pain in the limb loss population, there is a lack of clinical trials directly comparing the relative effectiveness of TMR to RPNI surgery nor is there clinically meaningful data assessing their impact on functional (i.e., prosthetic use) or patient-oriented outcomes (i.e., quality of life). Furthermore, there are large variabilities in TMR and RPNI surgery techniques and treatment pathways for patients struggling with neuromas and PLP in Canada. As a result, people with limb loss across Canada are not being afforded equitable access to these potentially life-changing surgeries that can alleviate their pain, enhance their ability to wear their prosthetic devices, and thereby improve their quality of life. This planning initiative aims to bring together surgeons, physical medicine and rehabilitation physicians, and people with limb loss to design the best care pathway for people with limb loss to gain better access to TMR/RPNI surgery. We will also plan a research grant to implement and evaluate this best-care surgical pathway. As a result of this work, a national set of standards will be established related to TMR and RPNI surgeries for the limb loss population, which can then be rigorously evaluated to determine which treatment procedures will have the best outcome for patients.