1. 2015;18;E245-E249Spontaneous Muscle Contraction with Extreme Pain after Thoracotomy Treated by Pulsed Radiofrequency
   Brief Commentary
   Yuecheng Yang, MD, Lihua Dai, MD, and Ma Ke, PhD.

BACKGROUND: Chronic post thoracotomy pain (CPTP) was a common complication after thoracotomy, while spontaneous muscle contraction (SMC) was very rare. Neuropathic pain components appeared in some CPTP patients. The patients with neuropathic pain (NPP) often suffered from more severe pain. OBJECTIVE: We presented a case of a 57 year- old Chinese male, suffering from SMC with extreme chronic pain after thoracotomy for 2 years. The patient was treated by pulsed radiofrequency (PRF). Then we reviewed the related progresses including recent view on NPP in CPTP, the possible mechanism of SMC, treatments for CTPT, and peripheral nerve treatments in NPP. STUDY DESIGN: Case report and review of the literature. METHODS: The patient was diagnosed as CPTP with SMC. After the experimental intercostal nerve block provided short-term analgesia, we performed PRF through the angulus costae on intercostal nerves under x-ray guidance. We performed PRF for 3 times in all, at an interval of 2 weeks. Then we had followed up the pain intensity, frequency and amplitude of SMC of this patient during the 2 years. RESULTS: The pain intensity decreased from 8 to 2 on the visual analogue scale (VAS). The frequency of muscle contraction was decreased by 90%, and the amplitude was decreased by 60%. The treatment also improved the patient’s sleep quality. These improvements were stable in 2 years’ follow-up. In our review of the literature, the SMC may be based on the pain-spasm-pain model. LIMITATION: Single case report. CONCLUSION: Pulsed radiofrequency provided good efficacy in CPTP with SMC in this case.