Neuraxial Neurolysis

Excerpt

Neurolysis is the application of chemical or physical agents to a nerve to cause a temporary or permanent degeneration of targeted nerve fibers. When the nerve fibers degenerate, it interrupts the transmission of nerve signals. If these nerve fibers are carrying nociceptive signals, it can, therefore, provide pain relief. The most frequently employed modes of neuroablative therapy: radiofrequency (heat), chemoneurolysis (chemical), and cyroablation (cold)[Zhou et al.]. Neuroablative procedure and neuraxial neurolysis, in particular, has been described for cancer pain. Refractory pain management at the end of life is an enormous public health problem affecting at least 10 to 15% of patients with cancer. Options beyond the WHO analgesic ladder can play a significant role to relieve suffering and improve side effects in select patients.Neuroablation by chemical and thermal neurolysis or surgery can provide long-term control of severe cancer pain without substantial adverse effects.

Intrathecal chemical neurolysis (ICN) is an essential intervention in the treatment of cancer pain. Dogliotti first described intrathecal neurolytic blocks for chronic cancer pain in 1931. In recent years, alcohol and phenol have been the substances most commonly used for this purpose. No randomized control trials exist that evaluate the effectiveness of this intervention, so the literature consists of observations, reports and book chapters reflecting the opinions of experienced clinicians. Neuraxial neurolysis is dangerous, but when used appropriately in carefully selected patients, it is effective, inexpensive, quickly accomplished, and associated with a low incidence of severe morbidity. In appropriately selected patients neuraxial neurolysis can decrease opioid usage and improve the quality of life.The use of neuraxial neurolysis has decreased in recent years due to other interventional treatments in terminal cancer. Neuraxial neurolysis has the advantage of providing immediate analgesia and pain control. It might also be especially useful in developing countries because unlike many other interventional techniques it doesn’t require C-arm or imaging and fewer follow-up visits.