Case Report Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization Ernesta Magistroni, 1 Davide Ciclamini, 2 Bernardino Panero, 2 and Valter Verna 3 1 Physical Medicine and Rehabilitation Department, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy 2 Microsurgery Unit, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy 3 Department of Imaging, Trauma Center, CTO Hospital, Via Zuretti 29, 10100 Torino, Italy Correspondence should be addressed to Davide Ciclamini; davide.ciclamini@gmail.com Received 23 July 2014; Revised 10 November 2014; Accepted 16 November 2014; Published 26 November 2014 Academic Editor: Di Lazzaro Vincenzo Copyright © 2014 Ernesta Magistroni et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Neuropathic pain following brachial plexus injury is a severe sequela that is difcult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain afer nerve injury, even though the underlying mechanism remains unclear. Tis case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year- old man who sustained a complete lef brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has sufered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. Te median nerve received a PRF treatment at wrist level. Afer the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work afer a period of absence enforced by severe pain. Tis case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain. 1. Introduction Pulsed radiofrequency (PRF) was developed with the goal of providing reduction in pain through the use of electrical felds in the absence of neural injury [1]. Its frst application dates back to 1996. Te frst report of its use, in the dorsal root ganglion, appeared in e Clinical Journal of Pain in 1995 [2]. Prospective trials on the use of PRF have shown a benefcial efect on pain reduction in a variety of chronic pain conditions [3–6]. Te debate on the mechanisms underlying the efect of PRF continues in the literature [7, 8]. Rat cervical dorsal root ganglia were exposed to PRF, showing an increase in c-Fos immunoreactivity in the dorsal horn up to 1 week afer treatment [9]. Te potential long-term efect on the tar- geted nerve is a matter of concern. In vitro and in vivo studies have failed to demonstrate local tissue damage with the application of PRF [10, 11]. Hamann et al. [12] concluded that PRF has a biological efect that is unlikely to be related to overt thermal damage and that it targets small-diameter C and A- delta nociceptive fbers. Some recent laboratory studies (in rats) suggest that pulsed radiofrequency may modulate pain regulatory gene expression along the nociceptive pathway. According to laboratory data, PRF therapy could infuence the reversal of molecular efects of hypersensitivity developed from a peripheral nerve injury [13]. PRF is a technique designed to give long-term pain relief, consisting of short bursts of PRF delivered to a target nerve to produce efects on signal nerve transduction. A 50 kHz current is usually delivered in 20 ms pulses at a frequency of 2 Hz for a period of 120 s. Te procedure may be ultra- sound guided, fuoroscopy guided, or computed tomography guided, depending on the site to be treated. PRF has also pre- viously been used in other felds such as radicular pain, face pain, postsurgical pain, facet arthropathy, myofascial pain Hindawi Publishing Corporation Case Reports in Medicine Volume 2014, Article ID 429618, 3 pages http://dx.doi.org/10.1155/2014/429618