Neurolytic Procedures

There is some evidence for benefit from procedures in this category in the treatment of pain in neurologic disease, especially characterized by disabling and painful spasticity. Favorable results using hyperbaric intrathecal phenol in such cases were reported nearly 50 years ago by Nathan,65[V] and similar results have emerged from a study by the author and others in patients with advanced MS.66[V]

Use of neurolytic procedures interrupting sensory pathways in an attempt to relieve pain may expose the patient to the risk of recurrent, resistant central pain consequent upon deafferentation, which may be extremely difficult to treat. By contrast, treatment of noci-ceptive, spasticity-contingent pain by selective motor neuronal/axonal lesioning should be free of this risk provided it is sufficiently selective.

Because of the invasive and potentially irreversible nature of these treatments, they have been largely restricted to patients with severe pain and disability; there are some data concerning their use in neurologic disease with severe spasticity.

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