Skip to main content

Neurolytic Injections for the Treatment of Pain in the Rehabilitation Patient

  • Chapter
  • First Online:
Book cover Comprehensive Pain Management in the Rehabilitation Patient

Abstract

Neurolysis is an underutilized technique of providing prolonged, and at times permanent, interruption of select neural pathways involved in nociception in cases of chronic, intractable pain. While malignancy-related pain is the most notable and recognizable indication for neurolytic block, any chronic, intractable pain condition that is resistant to more conservative analgesic approaches can be considered to be an indication for neurolysis. This is provided that the pain has a clearly defined etiology and can be reliably assessed using local anesthetic diagnostic blocks prior to proceeding to this irreversible modality. Neural interruption can be undertaken using physical, chemical, and thermal methodologies. The focus of this chapter is to describe techniques of using chemical agents as neurolytics for select indications of moderate-to-severe pain of the head and face, the thorax and abdomen, and of the spine and extremities in the rehabilitation patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Candido K, Stevens R. Intrathecal neurolytic blocks for treatment of cancer pain. In: Van Aken H, Spinal anaesthesia. Baillère’s best practice & research. Clinical anaesthesiology. Baillère Tindall: London. Vol 17 #3, 2003, p. 407–428.

    Google Scholar 

  2. Suvansa S. Treatment of tetanus by intrathecal injection of carbolic acid. Lancet. 1931;1:1075–8.

    Article  Google Scholar 

  3. Dogliotti AM. Traitement des syndromes doloreaux de la peripherie par l’alcoholisation subarachnoidienne des racines posterieures a leur émergence de la moelle epineri. Presse Med. 1931;39:1249.

    Google Scholar 

  4. Maher RM. Relief of pain in incurable cancer. Lancet. 1955;1:18.

    Article  Google Scholar 

  5. Maher RM. Neurone selection in relief of pain: further experiences with intrathecal injections. Lancet. 1957;1:16.

    Article  Google Scholar 

  6. Candido KD, Knezevic NN. Neurolytic blocks. In: Diwan S, Staatś P, editors. Atlas of pain medicine procedures. New York: McGraw Hill; 2015. p. 666–85.

    Google Scholar 

  7. Labat G. The induction of splanchnic analgesia. Ann Surg. 1924;80(2):161–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Candido K, Germanovich A, Ghaly R, Gorelick G. Knezevich: CT-scan guided Gasserian ganglion injection of dexamethasone and lidocaine for the treatment of recalcitrant pain associated with herpes simplex-1 of the ophthalmic division of the trigeminal nerve. Anesth Analg. 2011;112:224–7.

    Article  PubMed  Google Scholar 

  9. Arcidiacono P, Calori G, Carrara S, McNicol E, Testoni P. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database of Syst Rev 2011 3; CD007519. Doi:10.1002/14651858

    Google Scholar 

  10. Erdek M, Halpert B, González Fernández M, Cohen S. Assessment of celiac plexus block and neurolysis outcomes and technique in the management of refractory visceral cancer pain. Pain Med. 2010;11:92–100.

    Article  PubMed  Google Scholar 

  11. Liu S, Fu W, Liu Z, Liu M, Ren R, Zhai H, Li C. MRI-guided celiac neurolysis for pancreatic cancer pain: efficacy and safety. J Magn Reson Imaging. 2016;44(4) doi:10.1002/jmri.25246. [Epub ahead of print]

  12. Wyse J, Carone M, Paquin S, Usatii M, Sahai A. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol. 2011;29:3541–6.

    Article  PubMed  Google Scholar 

  13. Candido K, Philip C, Ghaly R, Knezevic N. Transforaminal 5% phenol neurolysis for the treatment of intractable cancer pain. Anesth Analg. 2010;110:216–9.

    Article  PubMed  Google Scholar 

Recommended Reading

  • Adams M, Benzon H, Hurley R. Chemical Neurolytic Blocks. In: Benzon H, Rathmell J, Wu C, Turk D, Argoff C, Hurley R, editors. Practical management of pain, 5th ed. Philadelphia: Elsevier; 2014. p. 784–93.

    Google Scholar 

  • Lawrence M, Hayek S, Goldner J. Celiac plexus, splanchnic nerve block, and neurolysis. In: Deer TR, editor. Comprehensive treatment of chronic pain by medical, interventional, and integrative approaches. The American academy of pain medicine textbook on pain management. New York: Springer; 2013. p. 427–34.

    Google Scholar 

  • Waldman S. Ultrasound-guided ganglion of Walther (impar) block. In: Waldman S, editor. Comprehensive atlas of ultrasound-guided pain management injection techniques. Philadelphia: Wolters Kluwer; 2014. p. 857–64.

    Google Scholar 

  • Wong G, Carns P. Neurolytic celiac plexus block. In: de Leon-Casasola, O, editor. Cancer pain: pharmacological, interventional and palliative care approaches. Philadelphia: Saunders-Elsevier; 2006. p. 409–16.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kenneth D. Candido M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

D. Candido, K., England, B. (2017). Neurolytic Injections for the Treatment of Pain in the Rehabilitation Patient. In: Carayannopoulos DO, MPH, A. (eds) Comprehensive Pain Management in the Rehabilitation Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-16784-8_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-16784-8_39

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16783-1

  • Online ISBN: 978-3-319-16784-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics