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Case Reports in Medicine
Volume 2014, Article ID 429618, 3 pages
http://dx.doi.org/10.1155/2014/429618
Case Report

Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization

1Physical Medicine and Rehabilitation Department, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy
2Microsurgery Unit, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy
3Department of Imaging, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy

Received 23 July 2014; Revised 10 November 2014; Accepted 16 November 2014; Published 26 November 2014

Academic Editor: Di Lazzaro Vincenzo

Copyright © 2014 Ernesta Magistroni et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain.