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Ultrasound-guided alcohol neurolysis and radiofrequency ablation of painful stump neuroma: effective treatments for post-amputation pain

Authors Zhang X, Xu Y, Zhou J, Pu S, Lv YY, Cheng Y, Du D

Received 9 November 2016

Accepted for publication 15 December 2016

Published 3 February 2017 Volume 2017:10 Pages 295—302

DOI https://doi.org/10.2147/JPR.S127157

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman

Xin Zhang, Yongming Xu, Jin Zhou, Shaofeng Pu, Yingying Lv, Yueping Chen, Dongping Du

Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China

Background: Post-amputation pain (PAP) is highly prevalent after limb amputation, and stump neuromas play a key role in the generation of the pain. Presently, PAP refractory to medical management is frequently treated with minimally invasive procedures guided by ultrasound, such as alcohol neurolysis and radiofrequency ablation (RFA).
Objective: To record the immediate and long-term efficacy of alcohol neurolysis and RFA. We first used alcohol neurolysis and then, when necessary, we performed RFA on PAP patients.
Study design: Prospective case series.
Setting: Pain management center.
Methods: Thirteen subjects were treated with ultrasound-guided procedures.
Results: All patients were treated with neurolysis using alcohol solutions guided by ultrasound. Seven (54%) of 13 subjects achieved pain relief after 1–3 alcohol injection treatments. The remaining 6 subjects obtained pain relief after receiving 2 administrations of ultrasound-guided RFA. After a 6-month follow-up evaluation period, pain quantities were also assessed. Both stump pain (including intermittent sharp pain and continuous burning pain) and phantom pain were relieved. The frequency of intermittent sharp pain was decreased, and no complications were noted during the observation.
Conclusion: The use of ultrasound guidance for alcohol injection and RFA of painful stump neuromas is a simple, radiation-free, safe, and effective procedure that provides sustained pain relief in PAP patients. In this case series, RFA was found to be an effective alternative to alcohol injection.

Keywords: post-amputation pain, neuroma, ultrasound-guided, alcohol neurolysis, radiofrequency ablation

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