| Background: Postamputation pain is common in patients with chronic neuropathic pain after amputation,including stump pain,phantom limb pain and phantom limb sensation.The mechanism is not entirely clear,and stump neuroma formation is one of the most important causes of postamputation pain.Long before neuroma resection had been reported for treatment of painful stump neuroma,but the results were contradictive.This study aims to evaluate the effectiveness and safety of ultrasound guided radiofrequency(RF)ablation and alcohol neurolysis for painful stump neuroma.Method: Twenty five patients were diagnosed as stump pain and/or phantom limb pain from June 2016 to September 2016 in pain management center of Shanghai No.6 People's Hospital and eighteen were included in the study.Inclusion criteria: stump neuroma was found by ultrasound examination;pain,which was similar to the stump or phantom,was induced by puncture towards the neuroma and ablated with radiofrequency and/or alcohol.Exclusion criteria: the follow-up time was less than 6 months after the last procedure;other treatments were received after RF treatment of alcohol injection(excluding drugs).Neuroma was detected under ultrasound guided in area where Tinel 's sign was positive.Radiofrequency were carried on the stalk of neuroma under regional anesthesia of nerve block.Alcohol was injected into neuroma.Before further treatment,the patients' general information was recorded,including age,gender,amputation location,duration,amputation area,NRS score of stump pain,whether combined with phantom limb pain.After the end of the treatment to 6 months all the patients were followed up by the total number of radiofrequency and alcohol injection.NRS score of the stump pain at 2 weeks and 6 months after the last treatment,changes of frequency of outbreak pain,changes of phantom limb pain,and the complications of treatment.Results: All the nineteen cases were selected for analysis.Both stump pain(including continuous pain and explosive pain)and phantom limb pain were alleviated after the procedure.Among them,two cases were treated only with radio frequency ablation,and seven cases were treated only with alcohol injection and divided into single alcohol group.The other ten cases got both two therapies who were divided into RF + alcohol group There was no difference in the pain score at the same time,the treatment times of alcohol,changes of phantom limb pain between the two groups.the difference was statistically significant only in the total times of treatment.Conclusion: For patients with postamputation pain,ultrasound can be used to find the neuroma,and reveal if there is relationship between the neuroma and neuropathic pain after amputation.Radiofrequency ablation and alcohol neurolysis under ultrasound guidance are effective and safe in relieving these neuropathic pains. |
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