Pulsed radiofrequency of lumbar dorsal root ganglia for chronic post-amputation stump pain.
BACKGROUND
Chronic pain following limb amputations is now a recognized chronic pain syndrome usually described in a combination of phantom and stump pain. Both stump and phantom pain continue to be significant treatment challenges. If pharmacotherapy does not provide effective analgesia for stump pain, a clinician has interventional options that frequently give only transient benefit, or have a high chance of failure in the long run.


METHODS
We selected 2 patients with primarily stump pain and difficulty tolerating the limb prosthesis. After a positive response to segmental nerve root blocks at L4 and L5, pulsed radiofrequency (PRF) was performed to the dorsal root ganglia (DRG).


RESULTS
Both patients experienced 50% pain relief or better for 6 months. Each patient tolerated the prosthetic limb and could function at a higher level.


CONCLUSIONS
PRF treatment of the DRG at the L4 and L5 nerve root level may be a therapeutic option for patients with peripherally mediated intractable stump pain. A decrease in pain intensity and improved toleration of the limb prosthesis was appreciated in both patients.
Ramanavarapu
Vidya
V
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
Simopoulos
Thomas T
TT
D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects*; D005260:Female; D005727:Ganglia, Spinal / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000601:surgery / Q000628:therapy*; D000078702:Radiofrequency Therapy