Abstract / Summary
Neuropathic pain is an important but underrecognized manifestation of amyotrophic lateral sclerosis (ALS). Although pain in ALS canarise from multiple mechanisms, including nociceptive pain, muscle cramps, and spasticity, neuropathic pain may occur as a distinct pain phenotype and can substantially affect patients' quality of life.Pharmacological agents are generally used as first-line treatments for neuropathic pain; however, some patients experience persistent symptoms despite conservative treatment.A 65-year-old man with ALS presented with diffuse paresthesia-like neuropathic pain involving the entire body.He had been diagnosed with ALS 18 months earlier and was wheelchair-dependent because of progressive motor impairment.The pain was persistent and rated 6 on an 11-point Numeric Rating Scale (NRS).Pharmacological treatment with pregabalin (Lyrica) 300 mg/day and acetaminophen/tramadol hydrochloride (325/37.5 mg) failed to provide meaningful pain relief.Because of the diffuse distribution and neuropathic characteristics of his symptoms, caudal epidural pulsed radiofrequency (PRF) was performed as a neuromodulatory treatment.Following treatment, the patient's pain decreased from NRS 6 to 2. The analgesic effect persisted for approximately 3 months, and no significant procedure-related adverse events were observed.Caudal epidural PRF may represent a potential interventional option for selected patients with ALS who experience refractory diffuse neuropathic pain.Its potential analgesic effect would be related to neuromodulation rather than focal neural blockade.