Feinberg professors receive grant to alleviate amputee pain

Mariana Alfaro, Assistant Campus Editor

Two Feinberg School of Medicine professors will use a grant from the U.S. Department of Defense to further research on a procedure that diminishes pain in amputees and helps them better control their prostheses.

Northwestern Memorial Hospital is one of four hospitals that will share the $2.4 million grant.

Dr. Todd Kuiken, director of The Center for Bionic Medicine in the Rehabilitation Institute of Chicago, and Dr. Gregory Dumanian, head of the Surgery-Plastics division at Feinberg, developed a procedure that allows the transferring of severed and amputated nerves to other muscle tissue where they can grow and develop, alleviating chronic pain and, when conditioned, enabling better movement of prosthetics.

“Dr. Kuiken told me about his nerve project in rats, how he would move a nerve from one place to another to get a signal out of the amputated nerve,” Dumanian said. “The concepts were something I knew would work on a human.”

Jesse Sullivan, the procedure’s first patient, underwent surgery during which Dumanian tested Kuiken’s idea. The surgery and treatment were successful.

Dumanian used the example of an amputation of a hand to explain the concept.

When a hand is amputated, nerves that used to go to the hand are still there because they are still connected to the brain, so signals from the brain still travel down the nerve. However, they arrive at a dead end, since the palm and fingers are missing. The muscles are still there and still work, but aren’t connected to any joints anymore, and therefore become useless.

“(We) take the amputated nerve, which is still connected to the fingers, and transfer it to the nerve that signals these muscles to have no function,” Dumanian said. “It’s a nerve transfer because you want to get the information out of the nerve that was going to the hand.”

Dumanian and Kuiken move these nerves and connect them to nearby muscles, making the nerve signals stronger since muscles are bigger than nerves. This procedure is called targeted intervention.

“The amputated nerves’ information from the brain is now becoming electrical activity that can be picked up through the skin,” Dumanian said.

One of the biggest questions the researchers faced was the possibility of “mismatching,” when a big nerve is sewn into a small nerve, which causes a painful growth called a neuroma.

“We were very worried 10 years ago that these nerve transfers … would be mismatched because you’re taking a big nerve that would go to the hand or the leg and transferring it to a much smaller motor nerve,” he said.

What the two doctors found, however, was that through this nerve transfer, the electric signals from the brain caused movement in the muscles and alleviated pain at the same time. By giving the nerves something to do, they stop hurting, they said.

“We have a lot of patients who have neuroma pain and one of the main reasons why they want surgery is to get rid of these neuromas and when we do normal neuroma removal, after a time it comes back,” Kuiken said.

Kuiken’s research has allowed many amputees better mobility and control of their prosthetics, because they are able to use messages from their brain to move muscles in their chest that then move the prosthetics, as demonstrated in a TED Talk he gave in 2011.

“This is the first workable brain machine interface,” Dumanian said. “A way to hook up what the brain is thinking to a mechanical device.”

With the grant, Kuiken and Dumanian will run a series of surgeries where patients will receive one of two treatments. One of the treatments is a traditional procedure that removes the neuroma, while the other treatment is targeted intervention. Patients will be unaware of the procedure they receive and over time, Kuiken and Dumanian will record their progress.

Walter Reed National Military Medical Center, University of Washington Medical Center and Harbor View Medical Center are also participating in the research. Dumanian said he has trained doctors at the three other facilities who will also be conducting the surgeries.

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