Neurolytics and cRF

[drf]

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I recently spent some time chatting with a very bright and engaging gentleman from China who specializes in pain. I was a bit surprised to learn that as a pain doc he is injection neurolytics and using continuous RF at 80' anywhere. He uses IDET, Decompressor and other disc modalities as well as peripheral nerve entrapment releases. He was wondering why us US guys aren't doing all these aggressive procedures. The simple answer is medicolegal and insurance barriers at least for me.

In any case, he stated that he is getting good results cRFing anything. For example, with lateral epicondylitis, he will simply use a 2.5 mm active tip RF needle and stick it into the soft tissue where there is maxiimum tenderness and burn it. No significant incidence of post-procedure neuromas or deafferentation problems.

It has been my practice to pulse everything except medial branches (even though I'm generally not impressed with pulsed RF) and only inject etoh/phenol in stumps or cancer patients.

Anyone else using neurodestructive techniques on peripheral nerves? Only sensory nerves? Sensory and motor nerves? Any problems months later?

 

[Aether2000]

1. He is not getting good results using CRF all over the body...he hasn't a clue. He doesn't have independent non-physician measurement of outcomes (required in some Asian cultures due to obsequiousness of the population towards physicians). It is very likely he has not done any study at all of his own population of patients to assess outcomes.
2. The Chinese are known for hubris and unreproducible outcomes
3. Phenol has been used for at least half a century throughout the world including the US. It can be useful in sensory nerve denervation with the caveat there is up to a 15% incidence of anesthesia dolorosa. It should never be used near the spine ala medial branches due to potential for tracking into the neuroforamen and onto the spinal nerve.

 

[SleepIsGood]

1. He is not getting good results using CRF all over the body...he hasn't a clue. He doesn't have independent non-physician measurement of outcomes (required in some Asian cultures due to obsequiousness of the population towards physicians). It is very likely he has not done any study at all of his own population of patients to assess outcomes.
2. The Chinese are known for hubris and unreproducible outcomes
3. Phenol has been used for at least half a century throughout the world including the US. It can be useful in sensory nerve denervation with the caveat there is up to a 15% incidence of anesthesia dolorosa. It should never be used near the spine ala medial branches due to potential for tracking into the neuroforamen and onto the spinal nerve.

not always true...

Anesth Analg. 2010 Jan;110(1):216-9. Epub 2009 Nov 12.

Transforaminal 5% phenol neurolysis for the treatment of intractable cancer pain.
Candido KD, Philip CN, Ghaly RF, Knezevic NN.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave., Chicago, IL 60657, USA.

This is the first case report of using a transforaminal approach for phenol administration. A 76-yr-old patient with a history of leiomyosarcoma and multiple metastatic lesions had unremitting pain in the right thoracic and lumbar regions and had prohibitive opioid-induced side effects. The patient underwent phenol neurolysis using a transforaminal approach in 2 stages at 3 levels (L3-4, L1-2, and T12-L1). The patient had complete resolution of pain, without any complications, and opioid treatment was nearly discontinued. Transforaminal phenol neurolysis is a reasonable treatment option for patients suffering from intractable pain for whom conventional therapies have proven ineffective.

 

[Jcm800]

not always true...

Anesth Analg. 2010 Jan;110(1):216-9. Epub 2009 Nov 12.

Transforaminal 5% phenol neurolysis for the treatment of intractable cancer pain.
Candido KD, Philip CN, Ghaly RF, Knezevic NN.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave., Chicago, IL 60657, USA.

This is the first case report of using a transforaminal approach for phenol administration. A 76-yr-old patient with a history of leiomyosarcoma and multiple metastatic lesions had unremitting pain in the right thoracic and lumbar regions and had prohibitive opioid-induced side effects. The patient underwent phenol neurolysis using a transforaminal approach in 2 stages at 3 levels (L3-4, L1-2, and T12-L1). The patient had complete resolution of pain, without any complications, and opioid treatment was nearly discontinued. Transforaminal phenol neurolysis is a reasonable treatment option for patients suffering from intractable pain for whom conventional therapies have proven ineffective.

ballsy

 

[SleepIsGood]

ballsy

That's what I thought too. However, apparently very appropriate if you continue to read the entire article.