Abstract

Introduction: Pulsed radiofrequency is emerging as a valid therapeutic option in chronic pain approach. The addition of ultrasound guidance allows the precise identification of nerve structures, that otherwise could not be easily approached.
Case report: A 49-year-old woman with severe postoperative located nociceptive and neuropathic pain after undergoing right partial scapulectomy for osteosarcoma of the scapula. For several years, the patient had been treated with a combination of a conservative rehabilitation program, oral and topical analgesics, and interventional techniques, with minimal results, baseline VNS of 8/10. After a successful dorsal scapular and spinal accessory block under ultrasound guidance, she underwent PRF regarding upper trapezius myofascial pain syndrome and dorsal neuropathic pain. Six months after PRF, there was a 50% reduction of pain, and the procedure was repeated for a long-lasting effect.
Conclusion: Postoperative nerve and muscle structural changes are a frequent source of chronic pain. Non-invasive treatment options are limited and oftentimes ineffective. Interventional treatments performed under ultrasound guidance allow the dynamic application of therapies such as radiofrequency ablation, with a pain neuromodulation effect.

Keywords:Spinal accessory nerve; Dorsal scapular nerve; Chronic pain; Neuropathic pain; Pulsed radiofrequency; Scapular osteosarcoma; Myofascial pain syndrome