Phantom limb pain relieved with pulsed radio frequency energy (PRFE) therapy

Two cases of reduction in phantom limb pain resulting from the application of a somewhat novel therapy, pulsed radio frequency energy (PRFE), are described.

Phantom limb pain is a debilitating pain syndrome with a high incidence (as high as 50-80% post amputation). It can occur immediately post amputation or become of lengthy duration.  As a chronic pain state, phantom pain can evolve through both inflammatory nociceptive and neuropathic processes.

Prompt treatment may prevent further disruption of the nervous system.  Treatments include medication, nerve blocks, electrical nerve stimulation and mirror therapy.  No one technique works in all cases. 

PRFE therapy triggers a cascade of biologic events thought to lead to an orchestrated wound healing response. Pain reduction with PRFE is thought to be related to its ability to stimulation the production of key anti-inflammatory proteins. 

Two cases are described in which patients with severe phantom limb pain had significant pain reduction associated with PRFE treatment. Both were older veterans who presented with advanced peripheral vascular disease, and history of multiple surgeries and limb revisions. In both cases, constant, sharp, stabbing pain (10/10 on VAS) had persisted for nearly 2 years.  Both patients had significant pain medication requirements. PRFE was initiated.

In response to PRFE, both patients experienced a significant reduction in phantom limb pain to levels of 4-5/10 which they termed as tolerable.  Medication requirements were markedly reduced within the first few weeks and continued to be so. Activity levels dramatically increased.

PRFE was very effective in these 2 patients that had phantom pain of long duration.  Further investigation of this nonpharmaceutical approach to phantom limb pain is warranted.