Targeted muscle reinnervation can be used in the NHS, while more evidence is generated, as a secondary procedure to treat problematic pain that has developed after limb amputation. It can only be used with special arrangements for clinical governance, consent, and audit or research.
Clinicians wanting to do targeted muscle reinnervation to treat problematic pain that has developed after limb amputation should:
Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
Patient selection should be done by a multidisciplinary team, which could include a rehabilitation medicine consultant.
More research is needed on targeted muscle reinnervation before it can be used in the NHS as a primary procedure to prevent problematic pain from developing after limb amputation.
This procedure should only be done as part of a formal research study and a research ethics committee needs to have approved its use.
More research is needed on:
patient selection
details of the technique used
the need for reintervention
short- and long-term outcomes, including effects on pain and quality of life.
Evidence on this procedure shows it can reduce pain that has developed after limb amputation and there are no major safety concerns. But, there is a lack of high-quality evidence. The evidence includes procedures that were done at the same time as amputation to prevent pain from developing (primary procedure) and after amputation to treat pain (secondary procedure).
Pain that develops after amputation can be difficult to treat and can have a substantial impact on quality of life. So, this procedure can be used with special arrangements to treat problematic pain that has developed after limb amputation.
It is unclear who would benefit from the procedure when it is done at the same time as amputation to prevent problematic pain. More evidence is needed on patient selection before the procedure is used in this situation.