Radiofrequency ablation 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. RFA is an alternative for eligible people who have
comorbidities or do not want to undergo more extensive surgery, such as hip or knee
arthroplasty.
External neurolysis Peripheral nerves move (glide) across bones and muscles. A peripheral nerve can be trapped by scarring of surrounding tissue which may lead to potential nerve damage or pain. An external neurolysis may be performed when scar tissue is removed from around the nerve without entering the nerve itself.
Celiac plexus neurolysis 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 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. 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. Lumbar sympathetic neurolysis is performed between the
L1-L4 vertebrae with separate injections at each vertebra junction. The chemicals used for neurolysis of the nerves cause destructive fibrosis and cause a disruption of the
sympathetic ganglia. The vasomotor tone is decreased in the area affected by the neurolysis, which in addition to arteriovenous shunting, create a light pink appearance within the affected area. Lumbar sympathetic neurolysis alters the ischemic rest pain transmission by changing
norepinephrine and
catecholamine levels or by disturbing afferent fibers. This procedure is mainly used only when other feasible approaches to pain management are unable to be used. The agent of choice is injected into or adjacent to a specific sensory nerve or into muscle fibers to dull neuronal pain signaling. The method involves compressing a gas (
carbon dioxide or
nitrous oxide) through a small aperture into a larger outer tube (1.4-2 mm diameter) at a lower pressure, enabling the gas to expand rapidly at the ablation tip. The efficacy of cryoneurolysis compared to other more common neurolytic methods for pain conditions is under study. ==Potential complications==