PULSED RADIOFREQUENCY ADJACENT TO CERVICAL DORSAL ROOT GANGLION FOR REFRACTORY PHANTOM LIMB PAIN: A SINGLE ARM INTERVENTIONAL STUDY

R.S. Sharma¹, A. Kumar² | ¹Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Gorakhpur, India; ²Department of Anaesthesia, All India Institute of Medical Sciences, Rishikesh, India

Abstract

Background and Aims. Multiple modalities, including medical and interventional therapies, have been tried in phantom limb pain patients so far with minimal success.¹ Thus, our study aimed to evaluate the effect of pulsed radiofrequency (PRF) adjacent to the cervical dorsal root ganglion (DRG) in patients with upper extremity phantom limb pain.
Methods. Following IEC approval and CTRI registration (CTRI/2023/07/091014), 27 patients with upper extremity refractory phantom limb pain were registered in our study. Following informed written consent and diagnostic intervention under ultrasound, a 22 G radiofrequency cannula was placed adjacent to the cervical DRG utilizing fluoroscopic guidance.². Once the final needle position was confirmed, two cycles of PRF were applied for 240 seconds on the same targets, with the endpoint being an electrode tip temperature of 42°C. The Visual Analog Score (VAS)³, Medication Quantification Scale (MQS)⁴, Global Perceived Effect (GPE) scale score, and Hospital Anxiety and Depression Scale (HADS)⁵ were evaluated post-treatment, at 1 month, and at 3 months and were compared with the pre-treatment value. A successful outcome was defined as a VAS score change that improved more than 50% at 3 months. Quantitative variables were analyzed using chi-square tests. A p-value < 0.05 was considered statistically significant.
Results. Twenty out of twenty-seven patients (74%) had excellent results with improvement in the VAS, MQS, GPE, and HADS scores at 3 months, which was also statistically significant. This outcome was also clinically significant, as the treatment reduced the dose of antineuropathic medications by more than 50% of the pre-intervention dose.
Conclusions. PRF on adjacent cervical DRG may be an effective and safe method of managing refractory phantom limb pain. However, more long-term follow-up and more patients are needed to establish the effectiveness of PRF treatment on refractory phantom limb pain.