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Destructive lesioning

In the past the destruction of nerve pathways carrying pain signals was common in Pain Medicine.  Nowadays it is considerably more unusual to do such procedures, although there are some exceptions to this particularly in patients with cancer pain.  These procedures are sometimes referred to as neurolytic blocks.  Neurolytic blocks are appropriate only when the pain is clearly identified as coming from specific nerves, but do not work for all pain types. For instance, neurolytic coeliac plexus blocks can work well for pancreatic cancer pain but tend to be considerably less effective for the pain of chronic pancreatitis.

Neurolytic procedures can be very effective in helping with some of the pains experienced by cancer patients. The downside of damaging nerves is that the effect may persist only for several months. But for someone with a terminal illness, this can be a lifetime.  However, they are not without their potential problems.  For instance, a coeliac plexus neurolytic block runs a tiny risk of causing paralysis. But if a patient has only a short time to live and is in so much pain that he cannot move, this may be felt an acceptable risk.  Neurolytic injections are a viable option when they offer a patient the best chance for dying without pain and without compromising quality of life.

 

 

We can use several different techniques to attempt to permanently block the transmission of pain impulses in nerves.  These can involve the use of cold (cryolesioning), heat (radiofrequency lesioning) or the injection of chemicals such as alcohol, phenol or glycerol onto the nerves.






 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk

Page updated 19/02/2016