title: Successful management of chronic postsurgical pain following total knee replacement.
abstract: We report reversal of chronic postsurgical pain (CPSP) along with functional restoration after total knee replacement (TKR) in two patients, using a combination therapy that included ultrasonography-guided pulsed radiofrequency (PRF) of nerves supplying the knee to provide pain relief, along with dry needling (DN) to relax myofascial triggers/bands that caused painful stiffness and restricted movement of muscles acting across the knee. Both patients showed demonstrable pain relief, as evidenced by changes in pain as assessed on the Numeric Rating Scale (patient 1: 4-9/10 [pre-treatment] to 0-3/10 [6 months post-treatment]; patient 2: 5-9/10 to 0-4/10), Oxford Knee Score (patient 1: 17 to 40; patient 2: 12 to 39), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs score (patient 1: 16 to 0; patient 2: 18 to 0), and Patient Health Questionnaire-9 score (patient 1: 17 to 2; patient 2: 20 to 2). The selection of the PRF-and-DN combination for treating post-TKR CPSP was based on a new idea that CPSP is a neuromyopathic phenomenon involving both sensory and motor neuropathy. It has evolved from our experience of 8 years. Physiotherapy worked synergistically with DN, optimizing muscle performance and pain relief.
authors.affiliation: Interventional Pain Management, Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Vas
authors.forename: Nishigandha
authors.initials: N
authors.lastname: Khandagale
authors.forename: Renuka
authors.initials: R
authors.lastname: Pai
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D059350:Chronic Pain / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000628:therapy*; D061208:Pulsed Radiofrequency Treatment / Q000379:methods*
keywords: Chronic Postsurgical Pain; Dry Needling; Myofascial Triggers; Neuromyopathy; Neuropathic Pain; Pulsed Radiofrequency