Neurolysis

Neurolysis is the application of physical or chemical agents to a nerve in order to cause a temporary degeneration of targeted nerve fibers. When the nerve fibers degenerate, it causes an interruption in the transmission of nerve signals. In the medical field, this is most commonly and advantageously used to alleviate pain in cancer patients. Neurolysis is the application of physical or chemical agents to a nerve in order to cause a temporary degeneration of targeted nerve fibers. When the nerve fibers degenerate, it causes an interruption in the transmission of nerve signals. In the medical field, this is most commonly and advantageously used to alleviate pain in cancer patients. The different types of neurolysis include celiac plexus neurolysis, endoscopic ultrasound guided neurolysis, and lumbar sympathetic neurolysis. Chemodenervation and nerve blocks are also associated with neurolysis. Neurolysis is a chemical ablation technique that is used to alleviate pain. Neurolysis is only used when the disease has progressed to a point where no other pain treatments are effective. A neurolytic agent such as alcohol, phenol, or glycerol is typically injected into the nervous system. Chemical neurolysis causes deconstructive fibrosis which then disrupts the sympathetic ganglia. This results in a reduction of pain signals being transmitted throughout the nerves. The effects generally last for three to six months. Certain neurolysis techniques have been reported to be used in the early 1900’s for the treatment of pain by the neurologist Mathieu Jaboulay. Early reported neurolysis helped treat vasospastic disorders such as arterial occlusive disease before the introduction of endovascular procedures. Celiac plexus neurolysis (CPN) is the chemical ablation of the celiac plexus. This type of neurolysis is mainly used to treat pain associated with advanced pancreatic cancer. Traditional opioid medications used to treat pancreatic cancer patients may yield inadequate pain relief in the most advanced stages of pancreatic cancer, so the goal of CPN is to increase the efficiency of the medication. This in turn may lead to a decreased dosage, thereby decreasing the severity of the side effects. 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. CPN can be performed by percutaneous injection either anterior or posterior to the celiac plexus. CPN is generally performed complementary to nerve blocks, due to the severe pain associated with the injection itself. Neurolysis is commonly performed only after a successful celiac plexus block. CPN and celiac plexus block (CPB) are different in that CPN is permanent ablation whereas CPB is temporal pain inhibition. There are multiple posterior percutaneous approaches, but no clinical evidence suggests that any one technique is more efficient than the rest. The posterior approaches generally utilize two needles, one at each side of the L1 vertebral body pointing towards the T12 vertebral body. Increasing the spread of the injection may increase the efficacy of the neurolysis. Endoscopic ultrasound (EUS)-guided neurolysis is a technique that performs neurolysis using a linear-array echoendoscope. The EUS technique is minimally invasive and is believed to be safer than the traditional percutaneous approaches. EUS-guided neurolysis technique can be used to target the celiac plexus, the celiac ganglion, or the broad plexus in the treatment of pancreatic cancer-associated pain.