Complex regional pain syndrome in a patient with spinal cord injury: management with pulsed radiofrequency lumbar sympatholysis

Abstract

Study design: Short communication.Objectives: To report a case with bilateral lower extremity complex regional pain syndrome (CRPS) in a patient with paraplegia occurring following spinal disc herniation surgery, who was treated successfully with pulse radiofrequency (PRF) lumbar sympatholysis. Setting: Departments of Physical Medicine and Rehabilitation, Algology Department of Anaesthesiology and Nuclear Medicine, Medical Faculty of Ege University, Izmir, Turkey. Methods: A 55-year-old woman had neuropathic pain in her lower extremities after T12-L1 disc herniation surgery. The pain decreased to a tolerable level with conservative treatment and her condition remained stable for the following 6 months; then she developed swelling, redness and severe burning pain in both feet. Physical examination showed edema and redness in the feet. On the basis of clinical findings and Tc-99m methylene diphosphonate (MDP) three-phase bone scintigraphy, she was diagnosed to have CRPS. Results: The patient underwent a diagnostic sympathetic ganglion blockade with bupivacaine, which resulted in a marked decrease in the pain and edema of the feet. Consequently, PRF lumbar sympatholysis was performed with a successful outcome in pain, edema and color changes in the feet. Conclusion: When treatment of CRPS fails with conventional modalities, PRF sympatholysis may be used for control of pain and other symptoms in such patients.

Pulsed radiofrequency treatment of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain: a randomized, placebo-controlled pilot study

“…There is wide variation in the literature on the reported duration of PRF. Although most studies have applied PRF for 120 seconds, others claim success with application for 4–10 minutes32,33 and some have also used a steroid at the end of treatment, which is an active treatment in itself 34…”

Transforaminal Epidural Injection of Local Anesthetic and Dorsal Root Ganglion Pulsed Radiofrequency Treatment in Lumbar Radicular Pain: A Randomized, Triple‐Blind, Active‐Control Trial

“…A statistically significant difference in pain relief was found in patients in the LPRF group compared to the LA group even at 6 months. According to available current literature, PRF for 120 seconds has been used in the majority of studies, whereas some studies have effectively used prolonged PRF (4 to 10 minutes) . However, in most of the studies in which PRF was administered for 120 seconds, patients had effective relief of symptoms for only 3 months, or patients were followed for up to the same time interval.…”

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

“…Pulsed radiofrequency ablation (PRFA) has been recently described as an alternative technique that applies a relatively high voltage near a nerve without nerve injury 15 . 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 .…”