thoracic DRG RF (heat - not pulsed)

[PGY2]

Got a guy with right subcostal pain. Diagnosed with intercostal neuralgia by other physician. The pain is chronic and debilitating ( pain greater than 4 years). Failed all meds. Previous pain doc did cryotherapy to the intercostal nerve. He had 2 months relief. Came to me, evaluated him, ... responded well to ICNB but gave only short term relief. Did an intercostal phenol injection.

His intercostal pain is gone!!! He is so grateful.... however.....now he complains of right T10 pain radiating to the umbilicus which came on almost immediately after the phenol injection. Suspect T10 root damage. Did T10 SNRB which gave 100% relief for a couple of days. He wants this pain gone! He says it's just as bothersome as his previous pain.

Would any of you do a T10 DRG heat ablation? Pulsed not paid for. Have been looking for the CPT for the heat ablation... cant find that either. Anyone know what it is? Unlisted procedure 64999?

Thanks!

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[lobelsteve]

How about neuromodulation rather than neuroablation?

I've done some cross work for above and below SCS/PNS on DRG related pain issues.

Getting root in gutter at T5 and lead peripherally was tried under the rib on the intercostal, then over the rib. Patient liked stim sensation over the rib.

 

[PinchandBurn]

How about neuromodulation rather than neuroablation?

I've done some cross work for above and below SCS/PNS on DRG related pain issues.

Getting root in gutter at T5 and lead peripherally was tried under the rib on the intercostal, then over the rib. Patient liked stim sensation over the rib.

Nice pic.

So you just placed that on the rib. it doesnt seem like you placed it under the rib where the nerves typically are.

 

[Aether2000]

>50% of the time the nerve lies in the intercostal space and not adjacent to the artery in the intercostal groove. The reason we usually target the inferior aspect of the rib during injections is to have a backstop before advancing too far anteriorly.
I would recommend against any heat treatment to the DRG. There is already injury from phenol and further DRG destruction can make it worse. Give the patient anticonvulsants and time...