Plenary Session 1 | Opening Panel

Date: Thursday, October 23, 2025
Time: 5:30 PM to 7:00 PM
Level: Plenary

  • Treating Neuropathic Pain in 2025: From the OR to VR

    Description

    Neuropathic pain after peripheral nerve trauma, brachial plexus injury, complex regional pain syndrome (CRPS) and limb loss remains a barrier to function and quality of life. This interdisciplinary session brings surgeons and hand therapists together to demystify surgical approaches to neuropathic pain and to maximize utilization of non-surgical treatment strategies. Drs. Loeffler and Gaston will discuss the evolution and current role for surgical techniques including Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) in managing neuropathic pain. Marcie Siebert, CHT, will discuss her extensive experience with noninvasive, neurocognitive approaches including mirror therapy, graded motor imagery (GMI), and virtual reality in the form of Targeted Brain Rehabilitation (TBR). Through case-based presentations and discussion of collaborative treatment pathways, attendees will learn how and when to deploy these modalities, how to set realistic expectations, and how to administer perioperative and rehabilitation protocols that reduce pain, improve prosthetic control, and accelerate return to function.

    Objectives

    Describe the underlying mechanisms of neuropathic pain (peripheral vs central sensitization, cortical reorganization) in the context of peripheral nerve injury, amputation, complex regional pain syndrome (CRPS), and brachial plexus injuries.

    Recognize clinical features and diagnostic criteria that distinguish neuropathic pain

    Review current surgical interventions for neuropathic pain (e.g., nerve decompression, targeted muscle reinnervation (TMR), and regenerative peripheral nerve interface (RPNI) including patient selection criteria and expected outcomes for surgical management.

    Discuss integration of surgical strategies with rehabilitation and multimodal pain management.

    Describe the principles of mirror therapy and its role in cortical reorganization and pain reduction.

    Explain the process of graded motor imagery (GMI) and its application in conditions like CRPS and phantom limb pain.

    Integrate rehabilitative interventions (mirror therapy, GMI, and Virtual Reality) into comprehensive treatment plans pre- and post-operatively 

    Develop strategies to educate patients about these interventions and set realistic expectations.

    Identify opportunities for interdisciplinary collaboration between hand therapists, surgeons, and pain specialists.

    Speakers
    Glenn Gaston, MD
    Bryan J. Loeffler, MD
    Marcie Siebert, MS, OTR/L, CHT