Disclosures: Beau P. Sperry, BA: No financial relationships or conflicts of interest

Case Description: After a prognostic block with 2mL of 2% lidocaine that resulted in ≥ 80% pain relief for five hours, the patient underwent cooled radiofrequency ablation (C-RFA) of a large (2.2 x 3.4 cm) sciatic neuroma located in the infrapiriformis foramen evident on MRI neurogram. Under colocalization with fluoroscopy and ultrasound, following confirmatory sensory stimulation testing at 50 Hz, three discrete C-RFA lesions were placed with an 18 gauge, 4mm electrode using a generator setting of 60C˚ (intralesional temperature >80 C˚) for two minutes and thirty seconds per lesion.

Setting: Tertiary care hospital and academic medical center.

Patient: A 61-year-old woman with a history of below-knee amputation and severe phantom limb pain (PLP) due to a right residual limb sciatic neuroma at the infrapiriformis foramen status post neuroma resection. Previous treatment of PLP had included SSRIs, gabapentinoids, opioids, multiple prosthetic fit adjustments, TENS, acupuncture, and surgical resection of the saphenous nerve.

Assessment/Results: At one, three, and six months post-ablation, the patient reported 95%, 95%, and 95% reduction in PLP symptoms on the VAS, with complete remission of severe episodes of PLP. She indicated a Patient Global Impression of Change score consistent with “very satisfied” at each time point, as well as improved ambulation and duration of tolerable prosthetic use.

Discussion: This is a novel report of successful treatment of intractable PLP from a large sciatic neuroma at the infrapiriformis foramen utilizing C-RFA.

Conclusion: This case indicates that C-RFA may offer substantial relief to individuals with PLP recalcitrant to both medical and surgical management. Formal clinical outcome study is warranted in order to determine the attributable effect of C-RFA on pain, physical function, and health-related quality of life in patients with PLP secondary to post-amputation neuroma.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cooled-radiofrequency-ablation-of-a-large-sciatic-neuroma-at-the-infrapiriformis-foramen-for-recalcitrant-phantom-limb-pain-in-a-below-knee-amputee-a-case-report/