Ultrasound-Guided Interventions for Neuropathic Pain: A Narrative Pictorial Review

Abstract

Neuropathic pain presents a persistent therapeutic challenge, arising from diverse etiologies such as trigeminal neuralgia, postherpetic neuralgia, post-amputation pain, painful polyneuropathy, peripheral nerve injury pain, and painful radiculopathy. Given the limitations and side effects associated with pharmacologic treatments, interest in interventional therapies has surged. Herein, ultrasound guidance provides real-time, radiation-free visualization that enhances procedural accuracy and safety. This narrative review synthesizes current evidence on ultrasound-guided techniques-including nerve blocks, pulsed radiofrequency, hydrodissection, and peripheral nerve stimulation-in the management of neuropathic pain. These minimally invasive approaches demonstrate potential in providing significant and durable pain relief, enhancing functional outcomes, and reducing reliance on systemic medications. Notably, much of the existing literature comprises small-scale or observational studies and larger randomized controlled trials are therefore essential to confirm efficacy, define optimal treatment parameters, and inform clinical guidelines for broader adoption.

Keywords: chronic pain; injection; nerve block; sonography; ultrasound.

Figure 1

Cadaveric bony model reconstruction illustrating the supraorbital foramen (SF), infraorbital foramen (IF), and mental foramen (MF) (A), and ultrasound-guided injections targeting the supraorbital nerve (V1; needle trajectory indicated by the yellow arrow) (B), infraorbital nerve (V2; needle trajectory indicated by the red arrow) (C), and mental nerve (V3; needle trajectory indicated by the blue arrow) (D). CS, corrugator supercilii; LLS, levator labii superioris; DA, depressor anguli oris. The white square indicates the transducer footprint. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc. (Aurora, CO, USA).

Figure 2

Cadaveric bony model reconstruction (A), and ultrasound images (B), illustrating ultrasound-guided injections targeting the maxillary nerve (V2; needle trajectory indicated by the yellow arrow) and mandibular nerve (V3; needle trajectory indicated by the red arrow). TM, temporalis muscle; LPM, lateral pterygoid muscle; COP, condylar process; LPP, lateral pterygoid plate. The white square indicates the transducer footprint. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.

Figure 3

Cadaveric sagittal cross-sectional image (A), and corresponding ultrasound image (B), illustrating an ultrasound-guided erector spinae plane block, with the needle trajectory indicated by the yellow arrow. TRA, trapezius; LoT, longissimus thoracis; TP, transverse process; PLE, pleura. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.

Figure 4

Cadaveric bony model reconstruction (A), and ultrasound images illustrating two approaches for paravertebral block: the parasagittal oblique approach (B) (needle trajectory indicated by the yellow arrow), and the transverse short-axis approach (C) (needle trajectory indicated by the red arrow). TRA, trapezius; LoT, longissimus thoracis; TP, transverse process; PLE, pleura. The white square indicates the transducer footprint. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.

Figure 5

Cadaveric axial-sectional image (A), and corresponding ultrasound image (B), illustrating ultrasound-guided injection of the C5 nerve root (asterisk), with the needle trajectory indicated by the yellow arrow. Cadaveric axial-sectional image (C), and corresponding ultrasound image (D), illustrating ultrasound-guided injection of the C6 nerve root (hashtag), with the needle trajectory indicated by the red arrow. AT, anterior tubercle; PT, posterior tubercle; SCM, sternocleidomastoid.

Figure 6

Cadaveric axial-sectional image (A), and corresponding ultrasound image (B), illustrating ultrasound-guided stellate ganglion block. The needle trajectory (yellow arrow) targets the region deep to the prevertebral fascia (dashed white line) overlying the longus colli (LC) muscle. AS, anterior scalene; SCM, sternocleidomastoid.

Figure 7

Cadaveric axial-sectional image (A), and corresponding ultrasound image (B), illustrating an ultrasound-guided serratus anterior (SA) plane block, with the needle trajectory indicated by the yellow arrow. LD, latissimus dorsi; R, rib; PLE, pleura. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.

Figure 8

Cadaveric axial-sectional image (A), and corresponding ultrasound image (B), illustrating an ultrasound-guided lumbar plexus block, with the needle trajectory indicated by the yellow arrow. SAP, superior articular process; L4/5 D, intervertebral disc between L4 and L5. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.

Figure 9

Cadaveric bony model reconstruction illustrating the sciatic nerve of the lower extremity (A), and ultrasound-guided injections targeting the sciatic nerve (double asterisks; needle trajectory indicated by the yellow arrow) near its distal bifurcation (B), the common peroneal nerve (hashtag; needle trajectory indicated by the red arrow) near the fibular head (FH) (C), and the tibial nerve (single asterisk; needle trajectory indicated by the blue arrow) near the medial malleolus (MM) (D). BIF, biceps femoris; GAS_L, lateral gastrocnemius; TP, tibialis posterior; FDL, flexor digitorum longus. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.

Figure 10

Cadaveric axial-sectional image (A), and corresponding ultrasound image (B), illustrating an ultrasound-guided sciatic nerve (asterisk) block, with the needle trajectory indicated by the yellow arrow. GMAX, gluteus maximus; SG, superior gemellus; OI, obturator internus; IS, ischium. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.

Figure 11

Cadaveric sagittal section (A), and corresponding ultrasound image (B), illustrating a caudal block, with the needle trajectory indicated by the yellow arrow. MSC, median sacral crest; SCL, sacrococcygeal ligament. Cadaveric images adapted from cadaveric images provided by the Visible Human Project^® of the National Library of Medicine. Excerpts featured in the VH Dissector are used with permission from Touch of Life Technologies Inc.