Disclosures: Athanasios Tzaras, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 49-year-old male with intercostal neuralgia.

Case Description: The patient presents to an outpatient pain management clinic with complaints of persistent pain isolated over his right ninth rib. He suffered a posterior right ninth rib fracture following a fall from standing and underwent partial resection of his right ninth rib due to nonhealing fracture. He experienced partial pain relief with a diagnostic right ninth intercostal block that lasted for several weeks, and therefore underwent a right ninth and tenth intercostal nerve injection with pulsed radiofrequency (PRF) ablation using fluoroscopic guidance. Two pulsed lesions at 42°C for 150 seconds were created within 1cm at the 9th and 10th intercostal nerves.Assessment/

Results: Following the first ablation, he reported near complete relief of pain that lasted approximately one month, then slow return of pain over the next five months. He received a second PRF ablation of his right ninth and tenth intercostal nerve six months following the first.

Discussion: Intercostal nerves arise from the somatic nervous system and consist of motor and sensory components. Intercostal neuralgia manifests as constant intense dysesthetic pain. Treatment is challenging and often requires a multidisciplinary approach. Radiofrequency ablation is a minimally invasive procedure used in treating chronic pain syndromes. PRF ablation is a safe alternative to traditional conventional radiofrequency (CRF) ablation by delivering short bursts of radiofrequency and allowing cooling of the electrode.

Setting: Outpatient pain management clinic.

Conclusion: Intercostal neuralgia is a neuropathic condition that manifests as constant intense dysesthetic pain. PRF ablation is a minimally neurodestructive technique that serves as an alternative to CRF ablation, with reduced risk of motor deficits, neuritis-like reactions, deafferentation pain syndromes, and nearby tissue destruction. There is limited amount of literature supporting the effectiveness of PRF ablation. Our case illustrates that PRF ablation is a safe and effective alternative to CRF ablation in treating intercostal neuralgia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pulsed-radiofrequency-ablation-in-the-treatment-of-intercostal-neuralgia-a-case-report/