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Final Program


Final Program

Pain

1303 - Pulsed Radiofrequency Ablation (RFA) for Radiation-Induced Brachial Plexopathy: A Targeted Approach to Neuropathic Pain

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: A 62-year-old female with a history of breast cancer (T2 N0 M0 right breast invasive ductal carcinoma, triple negative) status-post double mastectomy, lymph node dissection, and radiation (30 fractions in total) to the right chest wall presented with chronic painful paresthesias and weakness involving the right arm and forearm secondary to radiation-induced brachial plexopathy (RIBP). She previously had not tolerated gabapentin or pregabalin due to cognitive side effects, and despite being on therapeutic duloxetine daily, she continued to have debilitating paresthesias. Thus, ultrasound-guided right supraclavicular brachial plexus pulsed RFA was pursued.

Case Description: Three pulsed RFAs of the brachial plexus via the supraclavicular approach were performed over two-and-a-half years utilizing a 20 Gauge 10 mm active tip needle (settings: 2 Hz, 20 msec pulsations, 42 degrees C, 4 minute duration), with a post-RFA injection of bupivacaine and dexamethasone. She reported a range of 80-97% relief of her symptoms that lasted over 7–9-month periods. She also demonstrated improvements in pain scores with subjective reports of functional improvement without worsening weakness.

Discussions: Pulsed RFA is an experimental approach to treat focal pain secondary to RIBP without destruction of the target. The pulsatile nature allows target tissue temperature to not exceed 42°C. Several cases of pulsed RFA for brachial plexus-induced pain have been described, including for the treatment of radiation-induced plexopathy.

Conclusions: RIBP is often a debilitating, long-term complication of radiation therapy directed at the chest, axillary region, thoracic outlet, or neck, resulting in sometimes irreversible progressive neurological injury of the brachial plexus. Brachial plexus pulsed RFA may be beneficial in improving pain and function for patients with RIBP.