Disclosures: Payaum A. Ahmadi, BS: No financial relationships or conflicts of interest

Case Diagnosis: Phantom limb syndrome, chemotherapy-induced chronic peripheral neuropathy

Case Description: A 61-year-old female presented with a past medical history of primary osteosarcoma of the right lower extremity. Patient failed previous limb-sparing procedures and neoadjuvant polychemotherapy, and ultimately underwent right BKA. At initial presentation, patient reported 10 years of worsening phantom limb pain and chemotherapy-induced chronic peripheral neuropathy of the remaining stump. Patient was rarely able to tolerate prosthetic limb due to multifactorial pain, and compensatory antalgic gait was observed even when using prosthetic limb. This left the patient with major arthritic changes to the left hip, knee, and ankle joints. Patient was unable to ambulate without durable medical equipment (DME). Previous medical management had failed, including an infusion pump of nerve blocking medication. DRG stimulator trial was recommended and leads were placed at the right L3, L5, and S1 regions.

Setting: Outpatient PM&R/Pain practice

Assessment/Results: Following trial significant pain reduction was reported with no adverse effects after 1 week, with more than 75% improvement in pain. DRG stimulation alleviated both the phantom limb pain and long-standing peripheral neuropathy. Visual analog scale pain score decreased from a constant 10 to 2. Pain Disability Index changed from 61 to 10. Most importantly, the patient’s gait mechanics normalized and was able to ambulate with prosthetic limb, without DME. Permanent implant is pending.

Discussion: This patient did not respond to prior conservative or interventional treatments and had intractable and disabling pains, despite continuous infusion of peripheral nerve blocking pain. Therefore, more than 75% pain relief as well as improvement in all activities of daily living provided by the DRG trial should be considered success.

Conclusion: It is essential to consider DRG stimulation as an option for patients with phantom limb syndrome and chemotherapy-induced peripheral neuropathy. Delaying such neuromodulatory interventions long after failure of medical management can have negative and irreversible effects.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dorsal-root-ganglion-drg-stimulator-trial-eradicates-phantom-limb-syndrome-and-chemotherapy-induced-peripheral-neuropathy-a-case-report/