Neurolysis

What is neurolysis?

Neurolysis is a pain management procedure that involves destroying a nerve with a chemical injection near it. The injected chemical is typically alcohol (ethanol), phenol or glycerol.

Nerves are like cables that carry electrical signals between your brain and the rest of your body. These signals help you feel sensations (like touch and pain) and move your muscles. The goal of neurolysis is to prevent the targeted nerve from sending pain signals to your brain.

It’s important to note that healthcare providers may use the term “neurolysis” as a general way to describe the intentional destruction of a nerve. Other methods of destroying nerves include:

• Radiofrequency ablation (RFA). This procedure uses radio waves to create a current that heats a small area of nerve tissue to destroy it.
• Cryoablation. This procedure uses very cold temperatures (cryotherapy) to destroy a nerve.
• Surgical neurolysis (neurectomy). This procedure involves surgically dissecting (removing) a portion of a nerve or removing scar tissue from a nerve to provide pain relief.

Chemical neurolysis is one of several therapies for pain management. Like many of these types of therapies, the results can vary — chronic pain is very complex. Together, you and your healthcare provider will decide if neurolysis is a good option for you.

When would I need neurolysis?

Your healthcare provider may recommend chemical neurolysis if you have severe or chronic pain that doesn’t get better with conservative treatment, like physical therapy, complementary medicine and/or medication (analgesics). Neurolysis is typically for:

• Nerve pain (neuropathic pain)
• Cancer pain
• Visceral pain (stemming from internal organs)

Your provider may also recommend neurolysis for Morton’s neuroma. Less commonly, providers may recommend neurolysis to manage spasticity.

What are the different types of neurolysis?

The names of neurolytic procedures typically include the nerve or nerve plexus (branching network of nerves) that they’re targeting. Some examples of neurolytic procedures include:

• Celiac plexus neurolysis. This is a common neurolytic procedure to help alleviate upper abdominal pain, especially pain from pancreatic cancer and pancreatitis.
• Intercostal nerve neurolysis. This may help treat pain in your upper chest or abdomen from cancer metastasis or a thoracotomy procedure.
• Medial branch neurolysis. This may alleviate chronic lower back pain from facet joints (connections between bones in your spine).
• Neuraxial neurolysis. This is mainly a palliative care procedure to manage cancer pain that doesn’t respond to opioids.
• Superior hypogastric plexus neurolysis. This may help pelvic visceral pain.
• Trigeminal nerve neurolysis. This may help treat trigeminal neuralgia in your face.

Is neurolysis a nerve block?

Neurolysis and a nerve block are similar but different procedures. A nerve block aims to provide temporary pain relief (days to months) by helping nerves heal. Neurolysis aims to provide longer-term pain relief (several weeks to several months) by destroying nerves.

Healthcare providers inject different medications for these procedures as well. They inject an anesthetic and/or steroid near a nerve for a nerve block. They typically inject alcohol (ethanol), phenol or glycerol near a nerve for neurolysis.

How do I prepare for a chemical neurolysis procedure?

Preparation for a chemical neurolysis procedure may vary depending on the reason for it and where you’re receiving the injection. Your healthcare provider will let you know what to do, like if you need to adjust your medications. Be sure to follow their instructions.

In some cases, your provider may recommend sedation for the procedure. If you’re receiving sedation, you’ll need to fast for six to eight hours before it. You’ll also need someone else to drive you home after the procedure.

What happens during a neurolysis procedure?

There are several types of chemical neurolysis procedures that target different nerves, each with slightly different processes. But in general, you can expect the following during chemical neurolysis:

1. A provider will position you on an exam table in a certain way so they can easily access the injection point.
2. You may receive a mild sedative through an IV line in your arm to help you relax.
3. The provider will clean your skin with an antiseptic solution. They’ll give you an injection of a local anesthetic to numb the area where you’ll receive the chemical neurolysis injection. You may still feel a pinch or some discomfort as the needle enters your skin.
4. The provider may use imaging guidance, such as ultrasound, fluoroscopy (X-ray) or even CT scanning. This is so they can locate the exact spot where the injection needs to go. They’ll then inject the chemical as close to the affected nerve as possible.
5. After the procedure, you’ll rest while a provider observes you to make sure you don’t have any unexpected side effects. You’ll then be able to go home.

What are the benefits of chemical neurolysis?

The potential benefit of chemical neurolysis is temporary or permanent pain relief, which may help you function better day-to-day and/or improve your quality of life.

It’s important to note that not everyone experiences sufficient pain relief from neurolysis. You may need to try other treatment options if this is the case.

What are the risks or complications of neurolysis?

Each type of chemical neurolysis procedure has different risks and side effects. This is because the structures and other nerves near the targeted nerve vary. Because chemical neurolysis involves liquids, it’s possible that the liquid may spread to — and affect — other nearby tissues, nerves or blood vessels.

Possible side effects include:

• Infection at the injection site
• Bleeding at the injection site
• Paralysis if the chemical affects a nearby motor (movement) nerve
• Neuritis (nerve inflammation) — the targeted nerve could regenerate and lead to hyperesthesia (extreme sensitivity to touch)
• Bowel and/or urinary incontinence
• Sexual dysfunction

Your healthcare provider will go over the specific risks associated with the type of neurolysis you’re getting. Don’t hesitate to ask questions or raise concerns.

How long does chemical neurolysis last?

Pain relief from chemical neurolysis can vary significantly. It may last a few days, several weeks, months or even years. Each person responds differently. In general, phenol neurolysis may provide relief for eight to 12 weeks. Pain relief from alcohol neurolysis can last longer — from 12 to 24 weeks.

Your healthcare provider will be able to give you a better idea of what to expect and what the next steps will be if neurolysis doesn’t provide relief as expected.

When should I call my healthcare provider?

Contact your healthcare provider immediately if you experience any new symptoms or complications from the neurolysis procedure, like an infection, burning pain or muscle weakness.