Regenerative Peripheral Nerve Interface for the Management of Postamputation Pain in Oncology Patients.

Abstract

Challenges in chronic pain management among postamputation oncology patients have led to a shift in treatment paradigms. Regenerative peripheral nerve interface (RPNI) has shown promise in attenuating neuropathic pain after traumatic major limb amputations. This study evaluates the utility of prophylactic RPNI among oncology patients requiring major upper and lower extremity amputation. The primary outcome is to evaluate the effectiveness of prophylactic RPNI in preventing symptomatic neuromas among oncology patients. A retrospective review was conducted of patients with bone and soft-tissue tumors who underwent major limb amputation at a single academic institution between 2010 and 2023. Patients who underwent prophylactic RPNI ( n = 27) were compared with a control group ( n = 35). Outcomes included preoperative pain, postoperative neuroma formation, phantom limb pain, and chronic opioid use. Statistical analysis was performed using the chi-square test with GraphPad Prism 10. Twenty-seven oncology patients (70.4% male; mean age, 49.8 years) underwent amputation with prophylactic RPNI. The mean follow-up was 26.3 months (range, 3 to 58.5 months). The RPNI group included 9 upper and 18 lower extremity amputations. There were no symptomatic neuromas among the patients treated with RPNI. In contrast, symptomatic neuromas were identified among 28.6% of the controls. At 12 months postoperatively, 91.3% of patients treated with RPNI reported no or mild phantom limb pain compared with 70.8% of controls. In addition, 90% of patients treated with RPNI discontinued opioids within 6 months, compared with 50% of controls. Prophylactic RPNI at the time of major limb amputation for oncology patients is associated with a substantial reduction in pain levels, as well as opioid use.