Magistroni Ernesta, Ciclamini Davide, Panero Bernardino, Verna Valter
Physical Medicine and Rehabilitation Department, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy.
Microsurgery Unit, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy.
Case Rep Med. 2014;2014:429618. doi: 10.1155/2014/429618. Epub 2014 Nov 26.
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.
臂丛神经损伤后神经性疼痛是一种难以治疗的严重后遗症。尽管其潜在机制尚不清楚，但脉冲射频（PRF）已被证明可减轻神经损伤后的神经性疼痛。本病例报告描述了使用超声引导下的PRF减轻双水平上肢神经损伤中的神经性疼痛。一名25岁的男性因颈神经根撕脱导致完全性左臂丛神经损伤引起了我们的关注。自2007年以来，该患者一直患有神经性疼痛（NP），累及前臂尺侧、前臂近端三分之一以及拇指。通过手术、康复和药物治疗均未获得疼痛缓解。在肘部水平对尺神经进行了超声引导下的PRF治疗。在腕部水平对正中神经进行了PRF治疗。治疗后，患者报告手部疼痛持续减轻。我们在视觉模拟评分（VAS）量表上测得疼痛减轻了70%。PRF治疗使我们的患者在因剧痛而缺勤一段时间后得以重返工作岗位。该病例表明，当药物治疗不足以控制创伤后神经性疼痛时，PRF是一种有用的工具。
