Title: Neuroma Management in a Patient with PNS for Phantom Limb Pain Post-Amputation

Authors: Shreya N. Patel, DO (Presenting Author); Amit Sharma, MD; Trent Emerick, MD

INTRODUCTION

• CRPS and Neuromas can develop after limb trauma or surgeries like BKAs, leading to chronic pain and complications with recovery and prosthetic use.

• Neuromas, or abnormal nerve growths at the amputation site, can significantly worsen residual limb pain and complicate prosthetic use, requiring targeted intervention.

• Comprehensive management of CRPS and neuroma-related pain, including medications, peripheral nerve stimulators, and nerve blocks, is crucial for improving patient outcomes and quality of life.

METHODS

• Patient: 63-year-old male with CRPS and phantom limb pain post-BKA experienced persistent residual limb pain due to a sciatic neuroma, managed with a nerve block and multimodal pain strategies

• The peripheral nerve stimulator (PNS) used in this case was the Curonix device, targeting sciatic nerve-related pain

• Ultrasonography identified a sciatic neuroma at the residual limb, followed by a nerve block using lidocaine and dexamethasone

RESULTS

• PNS provided significant relief for the patient’s phantom limb pain but did not alleviate residual limb pain

• The ultrasound-guided nerve block resulted in 80% pain relief, which lasted for about one week, allowing the patient to more comfortably wear a prosthetic limb.

• Future treatment involves radiofrequency ablation (RFA) of the neuroma to achieve long-term pain relief.