Pulsed Radiofrequency Treatment of Lower Extremity Phantom Limb Pain

Abstract

Our report shows that the sciatic nerve block with bupivicaine and clonidine, initiated approximately 3 years after amputation, produced modest short-term relief. The pulsed radiofrequency treatment resulted in long-term relief of phantom limb pain. The patient was able to wean herself off all oral medications and has been pain free for 4 months.

A Case of Subcutaneous Neuroma Presenting With Intractable Pain and Allodynia Over the Anteromedial Aspect of the Knee

“…16 Neuromas can be managed by both nonsurgical and surgical modalities, with nonsurgical treatments including lidocaine or corticosteroid injections, spinal cord stimulation, peripheral nerve stimulation, botulinum toxin, or phenol injection, and pulsed radiofrequency treatment. 1,2,[16][17][18][19] Recently described as a neuroma therapy, pulsed radiofrequency has proven especially effective in the treatment of refractory stump-neuroma pain and phantom limb pain. 18,19 Excisional biopsy is often performed in cases where the lesion is palpable, but as deafferentation pain may secondarily develop, long-term follow-up is necessary.…”

“…1,2,[16][17][18][19] Recently described as a neuroma therapy, pulsed radiofrequency has proven especially effective in the treatment of refractory stump-neuroma pain and phantom limb pain. 18,19 Excisional biopsy is often performed in cases where the lesion is palpable, but as deafferentation pain may secondarily develop, long-term follow-up is necessary. Recurrent or persistent symptoms after the excision of an interdigital neuroma often result from neuroma formation, nerve stump adhesions, accessory nerve branches, or adjacent neuromas, which typically recur within the first year after surgery.…”

Pulsed Radiofrequency Ablation for Residual and Phantom Limb Pain: A Case Series

“…However, the more interesting point is that RLP and PLP can be treated both at more proximal peripheral nerve site like sciatic nerve in Wilkes study and more distal portion of the nerve, such as neuroma in our case. Additionally, the persistent RLP despite blockage of the neuroma with local anesthetic is suggess other peripheral sources of ectopic activity, such as dorsal root ganglion 20 . This phenomenon explains why sometimes local block of a neuroma is not effective, but the respective peripheral nerve, spinal nerve block, or epidural block may have an effect on pain control in amputees clinically.…”

“…PRFA is a minimally invasive technique that has demonstrated success at reducing pain in several chronic pain conditions including low back pain, 16 trigeminal neuralgia, 17 post‐herpetic neuralgia, 18 and complex regional pain syndrome 19 . PRFA has recently been shown to control the phantom limb pain in a below knee amputee 20 . Here we report effective pain control using PRFA in 4 amputees who suffered above knee and above elbow amputation with unbearable RLP and PLP despite conservative management.…”

Splanchnic nerve radiofrequency ablation for treating resistant abdominal pain

“…RFA and pulsed radiofrequency (PRF) are effective in treating different painful conditions such as fascial pain using sphenopalatine ganglion or trigeminal RFA,[1] pain originating from somatic nerves and joints[2] as well as several other conditions.…”