American Society for Peripheral Nerve

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Interdisciplinary team management changes diagnosis and alters treatment in patients with refractory peripheral limb pain
Paige Fox, MD, PhD1, Emily Johnson, BA2, Catherine Curtin, MD3, Thomas J Wilson, MD1, Ian Carroll, MD2, Sandip Biswal, MD1, Amelie Lutz, MD1, Daehyun Yoon, PhD2 and Vivianne Tawfik, MD, PhD2, (1)Stanford University, Palo Alto, CA, (2)Stanford University, Redwood City, CA, (3)Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA

Objective: To evaluate the roles of an interdisciplinary team management utilizing MRN (magnetic resonance neurography) imaging of peripheral nerves on diagnosis and treatment of complex patients with chronic limb pain.

Design: Retrospective chart review

Setting: Academic medical center.

Subjects: All patients who underwent MRN and were discussed by our interdisciplinary team between January 1, 2015 and November 1, 2018.

Outcomes: Whether pre-review diagnosis changed after case discussed by the team

Results: A total of 58 patients, 17 males and 41 females, were included in the study. The majority of patients presented with lower extremity pain (75%, 43/58) and most patients were able to attribute their pain to an initiating event such as surgery (43%, 25/58), trauma (22%, 13/58) or fracture (12%, 7/58). In addition to MRN, patients underwent a variety of diagnostics such as nerve conduction tests and peripheral nerve block with ultrasound guidance. After interdisciplinary discussion and review of imaging, multidisciplinary treatment plans were initiated in all patients including medication optimization, physical therapy, pain psychology, nerve directed percutaneous ablation and surgical intervention. Interestingly, nerve targeted surgery was performed in 34% (20/58) cases. We then compared the referral diagnosis to the post-evaluation diagnosis and found that we changed the diagnosis in 78% of cases (45/58) most often from a non-specific diagnosis such as “neuropathy” to one that implicated a specific nerve (for example, “common peroneal nerve entrapment”).

Conclusions: This exploratory study demonstrates that MRN in combination with interdisciplinary team meetings results in more specific diagnoses and change in management for complex patients with refractory limb pain with standard treatments. The effect of this approach on patient outcomes is the subject of future studies.

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