Ultrasound-guided alcohol neurolysis and radiofrequency ablation of painful stump neuroma: effective treatments for post-amputation pain

Figures & data

Table 1 Patient characteristics

Case	Sex	Age (years)	Duration of symptoms prior to injection (years)	Amputation		Stump pain (NRS)		Phantom pain
				Site	Side	Intermittent sharp (paroxysmal)	Continuous burning (abiding)
1	F	57	18	Above knee	L	9	8	+
2	M	45	15	Above knee	L	10	9	+
3	M	48	8	Above knee	R	9	9	−
4	F	66	26	Below knee	R	10	7	+
5	M	67	22	Hip joint	L	10	7	+
6	F	82	42	Below elbow	R	10	6	−
7	F	32	3	Above elbow	R	9	7	+
8	F	58	16	Above knee	L	9	7	+
					R	9	8	+
9	M	62	24	Above knee	L	10	8	+
10	M	76	8	Above elbow	L	10	8	+
11	M	48	12	Shoulder joint	R	10	6	−
12	M	45	3	Below knee	R	10	9	+

Abbreviations: NRS, numerical rating scale; F, female; M, female; L, left; R, right.

Table 2 The assessment of pain relief during treatment period

Case	Amputation		Pain relief (alcohol injection)			Pain relief (RFA)		Total number of ultrasound procedures
	Site	Side	1st	2nd	3rd	1st	2nd
1	Above knee	L	Fair	Fair	Good	Excellent	Excellent	5
2	Above knee	L	Good	Excellent				2
3	Above knee	R	Good	Good	Good	Excellent	Excellent	5
4	Below knee	R	Good	Good	Excellent			3
5	Hip joint	L	Good	Excellent				2
6	Below elbow	R	Fair	Fair	Good	Excellent	Excellent	5
7	Above elbow	R	Excellent					1
8	Above knee	L	Fair	Fair	Fair	Good	Excellent	5
		R	Fair	Fair	Fair	Excellent	Excellent	5
9	Above knee	L	Good	Excellent				2
10	Above elbow	L	Good	Good	Excellent			3
11	Shoulder joint	R	Good	Excellent				2
12	Below knee	R	Fair	Fair	Fair	Excellent	Excellent	5
Total								45

Abbreviations: RFA, radiofrequency ablation; L, left; R, right.

Table 3 The assessment of immediate and long-term pain relief after treatment

Case	Amputation		Stump pain (NRS)						The change of frequency of paroxysmal pain		phantom pain	The change of phantom pain
			Intermittent sharp (paroxysmal)			Continuous burning (abiding)
	Site	Side	Before	2 weeks	6 months	Before	2 weeks	6 months	2 weeks	6 months		2 weeks after treatments	6 months after treatments
1	Above knee	L	9	1	2	8	0	2	Less	Less	++	−	+
2	Above knee	L	10	1	2	9	2	4	Less	Equal	++	−	−
3	Above knee	R	9	2	1	9	1	4	Less	Less	−	n/a	n/a
4	Below knee	R	10	2	3	7	1	3	Equal	Less	++	+	+
5	Hip joint	L	10	2	2	7	2	2	Less	Less	++	−	−
6	Below elbow	R	10	2	2	6	2	1	Less	Less	−	n/a	n/a
7	Above elbow	R	9	2	4	7	3	3	Less	Less	++	+	+
8	Above knee	L	9	0	1	7	0	1	Less	Less	++	−	+
		R	9	1	2	8	0	1	Less	Less	++
9	Above knee	L	10	0	2	8	2	3	Less	Less	++	+	+
10	Above elbow	L	10	1	4	8	2	4	Less	Less	++	++	++
11	Shoulder joint	R	10	2	3	6	1	1	Less	Equal	−	n/a	n/a
12	Below knee	R	10	3	2	9	2	2	Less	Less	++	+	+
SD			0.50636968	0.87705802	0.94733093	1.04390785	0.96076892	1.19292788
Median			10	2	2	7	2	2

Notes: ++, with a stronger phantom pain; +, with a weaker phantom pain; −, the phantom pain is not present.

Abbreviations: NRS, numerical rating scale; L, left; R, right; n/a, not applicable; SD, standard deviation.

Figure 1 Detection of the neuromas.

Notes: (A) Using ultrasound probe to scan the stump limb. (B) The transverse axial view of neuroma. (C) The longitudinal axial view of neuroma. The dotted line indicates neuroma.

Figure 2 Representative images of alcohol neurolysis to the neuromas.

Notes: The injection needle was inserted into the neuroma body, and the tip was adjusted to evoke the extreme pain. The dotted line indicates neuroma.

Figure 3 RF procedure.

Notes: (A) The RF generator machine. (B) The transverse axial view of neuroma body. (C) RF needle was advanced to the responsible nerve 5 mm away from neuroma stalk. The dotted line indicates neuroma.
Abbreviation: RF, radiofrequency.

Figure 4 The variation of neuromas.

Notes: (A) Three neuromas origin from 1 nerve. (B and C) The nerve immediately proximal to the neuroma is pathological. The nerve is usually swollen, with its diameter as large as 1 cm or more. (B) is the transverse axial view of neuroma body, and (C) is the transverse axial view of neuroma stalk. The dotted line indicates neuroma.