Shahrzad Keramati1,2, Marc Price-Morris2 and Ahilraj Siva2,3*
1Department of Medicine, Northern Ontario School of Medicine, Canada
2Department of Medicine, The Pain Clinic, Canada
3Department of Medicine, McMaster University, Canada
Background: Lumbar sympathetic nerve block and Pulsed Radiofrequency (PRF) are rarely performed in Chronic Central Neuropathic Pain (CCNP). We present a combination of bilateral lumbar sympathetic nerve block and ultrasound guided PRF in the management of spinal cord injury related CCNP that was refractory to medical and physical therapy. Case Report: A female (60 to 70 years old) presented to our pain clinic with severe bilateral electrical and burning leg pain diffusely from her hip to toes, covering both volar and dorsal aspects of the limbs along with sensitivity to touch. She described her pain as 10/10 disrupted her functional ability despite taking high dose painkillers. We performed, first, bilateral lumbar sympathetic nerve block at L3 that led to complete pain relief of 0/10 of the proximal limbs from her back to the distal thigh after three months; then, ultrasound guided PRF of bilateral sciatic nerves at the popliteal fossa that yielded a significant reduction in pain of her lower legs, with a severity of 4/10 and sensitivity to touch. In addition, improvement in function and sleep along with a significant reduction in painkiller dosage earned patient high satisfaction. Conclusion: Lumbar sympathetic nerve blockade can be a therapeutic option for spinal cord injury related chronic central neuropathic pain. And subsequently PRF can be effectively applied primarily to the peripheral nervous system as the second stage of the management of SCI associated central neuropathic pain.
nerve block; Pulsed radiofrequency; Chronic pain; Central neuropathic pain
Keramati S, Price-Morris M, Siva A. A Combination of Lumbar Sympathetic Nerve Blockade and Pulsed Radiofrequency in Chronic Central Neuropathic Pain - A Case Report. Clin Case Rep Int. 2022; 6: 1341.