Percutaneous pulsed radiofrequency treatment of the splanchnic nerves for chronic flank pain secondary to non-obstructive nephrolithiasis

Chronic benign flank pain of unknown etiology presents a significant challenge for pain physicians, especially when interventional treatment options are limited. We report the case of a 26-year-old male with a history of chronic left flank pain, recurrent non-obstructing nephrolithiasis, and a complex urologic background, who was referred to pain management after failing to find relief through previous urologic interventions. Despite the absence of new obstructing stones, the patient's pain persisted. Initial splanchnic nerve blocks using 0.25 % bupivacaine and dexamethasone provided temporary relief, leading to the decision to proceed with pulsed radiofrequency (RF) treatment of the left splanchnic nerves. Under fluoroscopic guidance, the pulsed RF procedure resulted in significant pain reduction, which lasted for four to six months. Over the course of four years, the procedure was repeated six times, providing sustained relief and allowing the patient to resume normal activities, including school and work. This case highlights the potential effectiveness of pulsed RF as a viable option for managing refractory chronic flank pain when other treatments have failed.