Tariq Rayhan A., Mueller Michael, Green Michael S.
South Central Regional Medical Center
Allegheny General Hospital
is the application of chemical or physical agents to a nerve to cause a temporary or permanent degeneration of targeted nerve fibers. When the nerve fibers degenerate, it interrupts the transmission of nerve signals. If these nerve fibers are carrying nociceptive signals, it can, therefore, provide pain relief. The most frequently employed modes of neuroablative therapy: radiofrequency (heat), chemoneurolysis (chemical), and cyroablation (cold)[Zhou et al.]. Neuroablative procedure and neuraxial neurolysis, in particular, has been described for cancer pain. Refractory pain management at the end of life is an enormous public health problem affecting at least 10 to 15% of patients with cancer. Options beyond the WHO analgesic ladder can play a significant role to relieve suffering and improve side effects in select patients.Neuroablation by chemical and thermal neurolysis or surgery can provide long-term control of severe cancer pain without substantial adverse effects. Intrathecal chemical neurolysis (ICN) is an essential intervention in the treatment of cancer pain. Dogliotti first described intrathecal neurolytic blocks for chronic cancer pain in 1931. In recent years, alcohol and phenol have been the substances most commonly used for this purpose. No randomized control trials exist that evaluate the effectiveness of this intervention, so the literature consists of observations, reports and book chapters reflecting the opinions of experienced clinicians. Neuraxial neurolysis is dangerous, but when used appropriately in carefully selected patients, it is effective, inexpensive, quickly accomplished, and associated with a low incidence of severe morbidity. In appropriately selected patients neuraxial neurolysis can decrease opioid usage and improve the quality of life.The use of neuraxial neurolysis has decreased in recent years due to other interventional treatments in terminal cancer. Neuraxial neurolysis has the advantage of providing immediate analgesia and pain control. It might also be especially useful in developing countries because unlike many other interventional techniques it doesn’t require C-arm or imaging and fewer follow-up visits.
神经消融术是指应用化学或物理因子作用于神经，致使目标神经纤维发生暂时或永久性变性。当神经纤维变性时，会中断神经信号的传递。因此，如果这些神经纤维传导的是伤害性信号，就能缓解疼痛。最常用的神经消融治疗方式包括：射频（热）、化学性神经溶解（化学）和冷冻消融（冷）[周等人]。神经消融术，尤其是神经轴索神经溶解术，已被用于治疗癌痛。临终时难治性疼痛的管理是一个巨大的公共卫生问题，至少影响10%至15%的癌症患者。世界卫生组织止痛阶梯之外的治疗方法可在特定患者中发挥重要作用，缓解痛苦并改善副作用。化学和热神经溶解或手术进行的神经消融可长期控制严重癌痛且无明显不良反应。鞘内化学性神经溶解（ICN）是治疗癌痛的一项重要干预措施。1931年，多利奥蒂首次描述了鞘内神经溶解阻滞用于慢性癌痛的治疗。近年来，酒精和苯酚是最常用于此目的的物质。目前尚无评估该干预措施有效性的随机对照试验，因此文献主要是反映经验丰富临床医生观点的观察结果、报告和书籍章节。神经轴索神经溶解术有风险，但在精心挑选的患者中恰当使用时，它有效、廉价、操作迅速且严重并发症发生率低。在恰当挑选的患者中，神经轴索神经溶解术可减少阿片类药物的使用并改善生活质量。近年来，由于晚期癌症有其他介入治疗方法，神经轴索神经溶解术的使用有所减少。神经轴索神经溶解术具有能立即镇痛和控制疼痛的优势。在发展中国家它可能尤其有用，因为与许多其他介入技术不同，它不需要C形臂或影像学检查，随访次数也较少。
