Neurolysis

In the medical field, neurolysis is commonly used to alleviate pain, such as in people with various forms of cancer, chronic osteoarthritis or spasticity.

[1][3][4] Early neurolysis techniques were used in the 1900s for pain relief by the surgeon-neurologist Mathieu Jaboulay for vasospastic disorders, such as arterial occlusive disease before the introduction of endovascular procedures.

[6][2] A neurolytic agent such as alcohol, phenol, or glycerol is typically injected into specific sensory nerves assessed to be transmitting pain signals.

[7] Radiofrequency ablation (RFA) uses heat generated from radio waves to disrupt sensory nerve function in anatomical structures transmitting pain sensation to the brain, such as from the back, hip, neck, or knee.

[3][4][8] Clinical studies from 2023-25 reported that local injection of phenol was effective as a neurolytic treatment of sensory knee nerves to relieve chronic pain associated with osteoarthritis.

[5] CPN is also used to decrease the chances of a patient developing an addiction for opioid medications due to the large doses commonly used in treatment.

[12] EUS-guided celiac plexus neurolysis (EUS-CPN) is performed with either an oblique-viewing or forward-viewing echoendoscope and is passed through the mouth into the esophagus.

[12] Lumbar sympathetic neurolysis is typically used on patients with ischemic rest pain, generally associated with nonreconstructable arterial occlusive disease.

Lumbar sympathetic neurolysis alters the ischemic rest pain transmission by changing norepinephrine and catecholamine levels or by disturbing afferent fibers.

[13] Lumbar sympathetic neurolysis is performed by using absolute alcohol, but other chemicals such as phenol, or other techniques such as radiofrequency or laser ablation have been studied.

[6][2][14] The agent of choice is injected into or adjacent to a specific sensory nerve or into muscle fibers to dull neuronal pain signaling.

[6][2] As chemical denervation agents, phenol and alcohol are inexpensive, fast-acting, and can be readministered or boosted within months, while also possibly causing scarring or fibrosis.

[15][16][17] Among possible clinical complications are infection at the injection site, inflammation and pain at the injection or catheter site, bleeding or bruising from injury of small blood vessels, nerve injury, allergic reaction from a local anesthetic or neurolytic medication, or tinnitus and flushing from an agent like phenol.