A review of nonsurgical neurolytic procedures for neuropathic pain

Authors

Mayank Gupta, Kansas Pain Management, Overland Park, KS, USA.
Rany T. Abdallah, APICO Pain Management, Bear, DE, USA.
Alaa Abd-Elsayed, Anesthesiology Department, University Hospital, Madison, WI, USA.
Krishnan Chakravarthy, Solaris Research Institute, San Diego, CA, USA.
Miles Day, Department of Anesthesiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Timothy Deer, The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
Sudhir Diwan, Advanced Spine on Park Avenue; Department of Anesthesiology, Albert Einstein Medical College, Bronx; Pain Attending, Lenox Hill Hospital/Northwell Health, New York, NY, USA.
Nebojsa Nick Knezevic, Advocate Health - MidwestFollow
Neel D. Mehta, Och Spine at Weill Cornell New York Presbyterian Hospital, New York, NY, USA.
Michael E. Schatman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine; Department of Population Health, Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA.
Amol Soin, Ohio Pain Clinic, Centerville, OH; Department of Surgery, Wright State University, Dayton, OH, USA.
Peter Staats, National Spine & Pain Centers, Premier Pain Centers, Atlantic Beach, FL, USA.

Recommended Citation

Gupta M, Abdallah RT, Abd-Elsayed A, et al. A Review of Nonsurgical Neurolytic Procedures for Neuropathic Pain. J Pain Res. 2025;18:879-895. Published 2025 Feb 25. doi:10.2147/JPR.S491330

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Introduction:Ideally, a physical or chemical nonsurgical neurolytic procedure provides targeted neurolysis to relieve pain for a suitable length of time without causing complications. This narrative review focuses on five nonsurgical neurolytic procedures that are well-established and well-documented in the literature for the treatment of refractory neuropathic pain and peripheral neuropathies, in particular: two physical nonsurgical neurolytic techniques (cryoablation and radiofrequency ablation) and three chemoneurolytic agents (alcohol injection, phenol injection, and a high-concentration capsaicin 8% topical system).

Methods:Using the definition of nonsurgical physical and chemical neurolytic procedures for neuropathic pain, a focused literature search of the PubMed database for English-language, human studies published through July 2024 included, but was not limited to, the following search terms: "neuropathic pain" AND "cryoablation", "cryoneurolysis", "radiofrequency ablation", "alcohol neurolysis", "alcohol injection", "phenol neurolysis", "phenol injection", "chemoneurolysis", "topical capsaicin", and "TRPV1." While attempts were made to identify prospective clinical trials for each type of neurolytic procedure, information regarding the conduct and safety and efficacy of some of these nonsurgical neurolytic procedures was primarily limited to case studies and anecdotal evidence.

Results:The risk benefit basis of each technique is discussed, and recommendations for proper use based on the literature are summarized. Most techniques require ultrasound or fluoroscopy guidance. Pain relief typically ranges from 3 to 12 months, with repeat neurolytic procedures often required to maintain suitable levels of pain relief.

Conclusion:The authors provide their insights as to the best utilization of these identified nonsurgical physical and chemoneurolytic procedures for the treatment of refractory neuropathic pain in different patient populations based on neural targets. Together, these five nonsurgical neurolytic techniques provide patients and physicians with a variety of options for the treatment of refractory neuropathic pain.

Type

Article

PubMed ID

40027209