Treatment of bilateral refractory saphenous nerve entrapment neuropathy with pulsed radiofrequency

Abstract

The application of conventional radiofrequency (CRF) has been successfully used in many chronic pain conditions. Because of its neurodestructive effect, it can cause serious deafferantation sequelae in peripheral sensory neuropathies. Recently, pulsed radiofrequency (PRF) has generated enormous interest among interventional pain physicians for peripheral neuropathies because of its neuromodulatory effect. A 74-year-old male patient, came to our pain clinic with bilateral distal medial thigh pain for more than 10 years which was severe and refractory to medical management and other interventions. He had undergone multiple diagnostic tests and imaging, but the cause was not established. Finally, a diagnostic saphenous nerve block with local anesthetic and steroid provided almost complete relief for couple of days. Subsequently, PRF of bilateral saphenous nerve provided him excellent long-lasting pain relief. This case report highlights the importance of having high index of suspicion for entrapment neuropathy and a simple diagnostic nerve block can either confirm or refute the diagnosis. In other words, an early diagnosis and treatment can be started and unnecessary tests can be avoided.