Ultrasound-guided sciatic neuroma block for treatment of intractable stump pain

摘要

To the Editor:The recent case report by Fischler and Gross highlights the use of ultrasound guidance in the management of stump pain, currently called residual limb pain. Although not a new technique [2-4], ultrasound was used successfully by these authors. Their case report should further the use of ultrasound in managing chronic pain. However, the report would benefit from clarification of some salient points. The period from surgery to onset of pain is important in trying to discern the causes of residual limb pain. Neuroma typically develops over a period of two to three months. According to their report, the patient had a fall and received epidural blocks for two months, which puts the onset of pain as within a month after the amputation. If pain develops before one month, other causes, such as periosteitis, microfractures, abscjpss, muscle injury, and vascular occlusion, should be considered as neuroma pain typically starts anywhere from one month to a year , As there was magnetic resonanceimaging evidence of periosteitis with inflammation, infection, which may be aggravated by steroids, should be considered. Hyperalgesic response can have multiple causes, including myofascial pain syndrome which is a known cause for residual limb pain.