Chemoneurolysis is another very effective method of pain control. The injection of neurolytic agents interferes ways for prolonged periods.

Chemoneurolysis can be done intrathecally, intraepidurally, at the level of the plexus, or in peripheral nerves. Sympathetic demoneurolysis is frequently used for the treatment of sympathetically maintained pain as well as for the control of cancer pain and chronic noncancer pain.

Trigeminal neuralgia in particular typically responds well to Chemoneurolysis.

Cryoneurolysis

Another technique is cyroneurolysis or cryoanalgesia. The tip of a cryoprobe is frozen in nitrous oxide and then applied to the target nerve. Following the cryolesioning there is a second-degree axonal lesion, with subsequent recovery of function due to never regrowth in approximately 2 to 3 months.

Radiofrequency thermocoagulation

Radiofrequency thermocoagulation is a neurolytic method using heat. It is used in chronic pain for variety of conditions such as trigeminal neuralgia, facet syndrome, sympatholysis, etc.

Radiofrequency thermocoagulation has advantages over Chemoneurolysis because it allows better control over the extent of the lesion and its intensity. The risk of inducing deafferentation that can complicate the pain is negligible.


Steroid Injections

Local injections of corticosteroids have been widely used for the treatment of chronic pain. Injections of steroids such as triamcinolone in the epidural space, onto peripheral nerves, into articulations, and elsewhere have been successfully used for many years in patients with nerve root irritations, joint disorders, and other pathologic conditions. The use of corticosteroids has continued despite criticism.

Spinal Injection and Stimulation

Spinal narcotics are now used extensively for the management of chronic cancer pain or noncancer pain in selected patients.

Opioids can be administered via an epidural or intrathecal catheter. The Opioid delivery systems can be fully implantable or use external pumps. Most experts favor the fully implantable system using a programmable infusion pump.

There are many considerations that should be reviewed in making the choice of the system, including cost-effectiveness, and patient life expectancy. If the patient’s life expectancy is over 3 to 5 months, the programmable fully implantable system is usually preferable and more cost-effective than other systems.