&lt;p&gt;Ultrasonography-Guided Radiofrequency Ablation for Painful Stump Neuromas to Relieve Postamputation Pain: A Pilot Study&lt;/p&gt;

Pu, Shaofeng; Wu, Junzhen; Han, Qingjian; Zhang, Xin; Lv, Yingying; Xu, Yongming; Li, Chen; Du, Dongping

doi:10.2147/jpr.s283986

Cited by 8 publications

(10 citation statements)

References 27 publications

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“…A possible answer to this question may come from a different ablative technique—the radiofrequency. Several reports on the effect of ablative radiofrequency treatment (where target temperature far above 65°C has been reached) yielded positive results, 7,8,14 congruently with to what we aimed to achieve with the MRgHIFU treatment. However, in at least 1 study in patients with Morton's neuroma, US‐guided pulsed radiofrequency treatment (with only a sub‐ablative temperature of ~42°C rather than true ablative temperature) was administered.…”

Section: Discussionsupporting

confidence: 84%

Feasibility of Magnetic Resonance‐Guided High‐Intensity‐Focused Ultrasound (MRgHIFU) Ablation of Stump Neuromas for the Relief of Chronic Postamputation Neuropathic Pain

Nachtigal

Cozakov

Grinfeld

et al. 2022

J of Ultrasound Medicine

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Up to 70% of limb amputees develop chronic postamputation neuropathic pain (CPANP) which includes phantom pain and residual limb neuropathic pain due to neuroma formation. CPANP often requires invasive procedures aimed at neuroma ablation. Five amputees received 6 noninvasive magnetic resonance‐guided high‐intensity‐focused ultrasound MRgHIFU treatments ExAblate®, Insightec, Tirat‐Carmel, Israel). Although ablative temperature (>65°C) at the neuroma was reached in only 1 patient, pain intensity dropped from 5.7 at baseline to 4.3 and back to 5.6 at 3 and 6 month follow‐up. Post‐treatment bone necrosis was demonstrated in 1 patient. Although no firm conclusion about the effectiveness of MRgHIFU for CPANP could be drawn, further studies are warranted.

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Section: Discussionsupporting

confidence: 84%

Feasibility of Magnetic Resonance‐Guided High‐Intensity‐Focused Ultrasound (MRgHIFU) Ablation of Stump Neuromas for the Relief of Chronic Postamputation Neuropathic Pain

Nachtigal

Cozakov

Grinfeld

et al. 2022

J of Ultrasound Medicine

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“…Clinically, MRgFUS has potential as a non-invasive alternative to other ablation modalities, including radiofrequency ablation. Peripheral nerve ablation has been studied in a variety of cancerous (8,9,12,13) and non-cancerous conditions (6,10,11). Ablation has also been used to treat tumors with close proximity to neural structures (14).…”

Section: Discussionmentioning

confidence: 99%

“…There is great potential in extending the use of MRgFUS to the peripheral nervous system for treating conditions such as spasticity and chronic pain (6), which is supported by observations of FUS effects on nerve conduction (7). Ablation techniques, of which MRgFUS is a potential alternative, have been studied in peripheral nerve-related conditions including painful stump neuromas (8), peripheral nerve sheath tumors (9), inguinal neuralgia (10), and lumbar degenerative disease (11). Ablation has also been used for cancer pain relief (12,13) and to treat tumors with proximity to neural structures (14).…”

Section: Introductionmentioning

confidence: 99%

Peripheral Nerve Focused Ultrasound Lesioning—Visualization and Assessment Using Diffusion Weighted Imaging

et al. 2021

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Objectives: Magnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive targeted tissue ablation technique that can be applied to the nervous system. Diffusion weighted imaging (DWI) can visualize and evaluate nervous system microstructure. Tractography algorithms can reconstruct fiber bundles which can be used for treatment navigation and diffusion tensor imaging (DTI) metrics permit the quantitative assessment of nerve microstructure in vivo. There is a need for imaging tools to aid in the visualization and quantitative assessment of treatment-related nerve changes in MRgFUS. We present a method of peripheral nerve tract reconstruction and use DTI metrics to evaluate the MRgFUS treatment effect.Materials and Methods: MRgFUS was applied bilaterally to the sciatic nerves in 6 piglets (12 nerves total). T1-weighted and diffusion images were acquired before and after treatment. Tensor-based and constrained spherical deconvolution (CSD) tractography algorithms were used to reconstruct the nerves. DTI metrics of fractional anisotropy (FA), and mean (MD), axial (AD), and radial diffusivities (RD) were measured to assess acute (<1–2 h) treatment effects. Temperature was measured in vivo via MR thermometry. Histological data was collected for lesion assessment.Results: The sciatic nerves were successfully reconstructed in all subjects. Tract disruption was observed after treatment using both CSD and tensor models. DTI metrics in the targeted nerve segments showed significantly decreased FA and increased MD, AD, and RD. Transducer output power was positively correlated with lesion volume and temperature and negatively correlated with MD, AD, and RD. No correlations were observed between FA and other measured parameters.Conclusions: DWI and tractography are effective tools for visualizing peripheral nerve segments for targeting in non-invasive surgical methods and for assessing the microstructural changes that occur following MRgFUS treatment.

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“…Peripheral sensitization, central sensitization, and cerebral cortical reconstruction have been proposed as possible mechanisms underlying CPAP. However, the responsiveness of CPAP to available painkillers such as the anticonvulsant drug gabapentin and the hormone drug salmon calcitonin is very poor, which indicates that complicated mechanisms are involved [6][7][8][9][10][11][12]. Clinical studies have shown that treatments targeting the stump of an amputated peripheral limb can effectively relieve CPAP [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical studies have shown that treatments targeting the stump of an amputated peripheral limb can effectively relieve CPAP [ 13 , 14 ]. Our previous studies had also shown that ablation of the neuroma or the stump of the amputated limb with radiofrequency or surgery significantly improves the pain condition of patients [ 7 , 10 ], suggesting an essential role of peripheral nerves in the development of CPAP, but the exact mechanisms of how the neuromas or residual parts of peripheral nerves regulate CPAP still need further study.…”

Section: Introductionmentioning

confidence: 99%

Mechanosensitive Ion Channel TMEM63A Gangs Up with Local Macrophages to Modulate Chronic Post-amputation Pain

Tong

et al. 2022

Neurosci. Bull.

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Post-amputation pain causes great suffering to amputees, but still no effective drugs are available due to its elusive mechanisms. Our previous clinical studies found that surgical removal or radiofrequency treatment of the neuroma at the axotomized nerve stump effectively relieves the phantom pain afflicting patients after amputation. This indicated an essential role of the residual nerve stump in the formation of chronic post-amputation pain (CPAP). However, the molecular mechanism by which the residual nerve stump or neuroma is involved and regulates CPAP is still a mystery. In this study, we found that nociceptors expressed the mechanosensitive ion channel TMEM63A and macrophages infiltrated into the dorsal root ganglion (DRG) neurons worked synergistically to promote CPAP. Histology and qRT-PCR showed that TMEM63A was mainly expressed in mechanical pain-producing non-peptidergic nociceptors in the DRG, and the expression of TMEM63A increased significantly both in the neuroma from amputated patients and the DRG in a mouse model of tibial nerve transfer (TNT). Behavioral tests showed that the mechanical, heat, and cold sensitivity were not affected in the Tmem63a-/- mice in the naïve state, suggesting the basal pain was not affected. In the inflammatory and post-amputation state, the mechanical allodynia but not the heat hyperalgesia or cold allodynia was significantly decreased in Tmem63a-/- mice. Further study showed that there was severe neuronal injury and macrophage infiltration in the DRG, tibial nerve, residual stump, and the neuroma-like structure of the TNT mouse model, Consistent with this, expression of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β all increased dramatically in the DRG. Interestingly, the deletion of Tmem63a significantly reduced the macrophage infiltration in the DRG but not in the tibial nerve stump. Furthermore, the ablation of macrophages significantly reduced both the expression of Tmem63a and the mechanical allodynia in the TNT mouse model, indicating an interaction between nociceptors and macrophages, and that these two factors gang up together to regulate the formation of CPAP. This provides a new insight into the mechanisms underlying CPAP and potential drug targets its treatment.

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<p>Ultrasonography-Guided Radiofrequency Ablation for Painful Stump Neuromas to Relieve Postamputation Pain: A Pilot Study</p>

Cited by 8 publications

References 27 publications

Feasibility of Magnetic Resonance‐Guided High‐Intensity‐Focused Ultrasound (MRgHIFU) Ablation of Stump Neuromas for the Relief of Chronic Postamputation Neuropathic Pain

Feasibility of Magnetic Resonance‐Guided High‐Intensity‐Focused Ultrasound (MRgHIFU) Ablation of Stump Neuromas for the Relief of Chronic Postamputation Neuropathic Pain

Peripheral Nerve Focused Ultrasound Lesioning—Visualization and Assessment Using Diffusion Weighted Imaging

Mechanosensitive Ion Channel TMEM63A Gangs Up with Local Macrophages to Modulate Chronic Post-amputation Pain

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