Phantom limb pain and neuroma pain affect up to 80% of amputees, prompting interest in advanced nerve-targeting surgical techniques. This study compared pain outcomes in below-knee amputee patients undergoing Targeted Muscle Reinnervation (TMR) versus Regenerative Peripheral Nerve Interface (RPNI). Patient-reported outcomes included PROMIS Pain Interference 6b and 0–10 numerical pain ratings. Both techniques demonstrated similarly low residual pain levels: average phantom limb pain was 2.28 (TMR) vs. 2.0 (RPNI), and neuroma pain was 1.0 (TMR) vs. 2.3 (RPNI). PROMIS T-scores approximated the U.S. population mean, indicating minimal long-term pain interference. Satisfaction was universally high, with all patients stating they would undergo the procedure again. These results suggest that TMR and RPNI offer comparable and effective pain control, though larger and more diverse cohorts are required to evaluate outcomes across different amputation levels and activity profiles.