How does neurolysis of sympathetic plexus work?

Neurolysis of the sympathetic plexus disrupts the nerve signals that transmit pain sensations to the brain. This is mainly aimed at the network of nerves known as the sympathetic plexus, which can play a crucial role in certain types of chronic pain. Here is how neurolysis of sympathetic plexus can bring about pain relief:

• Targeting nerve signals: the sympathetic plexus is part of the nervous system involved in the “fight or flight” response and can influence pain perception. Neurolysis specifically targets this network to disrupt its ability to transmit pain signals.
• Chemical neurolysis: this involves injecting substances directly near the nerves. Alcohol and phenol are the most commonly used agents. Alcohol can create immediate discomfort due to its interaction with the nerve tissue but ultimately destroys the nerve fibres responsible for pain transmission. Phenol has a numbing effect and works by altering the structure of the nerve proteins, leading to the interruption of pain signals.
• Radiofrequency ablation (RFA): radiofrequency ablation is a modern approach that uses heat generated from radio waves to damage the nerve tissues. It is precisely controlled to minimise side effects and focuses on the nerves involved in pain transmission without affecting other areas.

The process either destroys the nerve fibres or alters them so that they can no longer efficiently transmit pain signals. This can provide significant relief from chronic pain conditions mediated by the sympathetic nervous system.

Benefits of neurolysis of sympathetic plexus

• Direct pain management
• Long-lasting relief
• Less reliance on medications
• Improved quality of life
• Minimally invasive
• Alternative for tough cases
• Effective, long-term solution to chronic pain

What conditions can neurolysis of sympathetic plexus treat?

Neurolysis of the sympathetic plexus can be particularly effective for:

• Complex regional pain syndrome: complex regional pain syndrome is a chronic condition characterised by severe pain, swelling, and changes in the skin.
• Neuropathic pain: pain from damaged nerves, which might include conditions like diabetic neuropathy or peripheral neuralgia.
• Cancer pain: cancer pain, such as pain associated with pancreatic cancer, can be alleviated through endoscopic ultrasound-guided neurolysis of the coeliac plexus.
• Chronic pancreatitis: persistent inflammation of the pancreas that leads to abdominal pain.
• Ischaemic rest pain: pain related to inadequate blood supply to the lower limbs, usually due to peripheral arterial disease.
• Vascular disorders: conditions that affect the blood vessels and lead to pain due to either reduced blood flow or overactivity of the sympathetic nervous system.

What results can I expect from neurolysis of sympathetic plexus?

After undergoing neurolysis of the sympathetic plexus, patients can generally expect several positive outcomes:

• Pain relief: the primary goal and most common outcome is a significant reduction in pain. Many patients report lasting relief from the chronic pain that was not manageable with other treatments.
• Reduced medication use: with effective pain management through neurolysis, there may be a decreased need for pain medications, including opioids. This can lead to fewer side effects and a lower risk of dependency.
• Improved quality of life: effective pain reduction can improve mobility, sleep quality, and overall daily functioning. Many patients experience a better quality of life post-procedure.
• Increased activity levels: with pain more effectively managed, some patients find they can increase their activity levels and participate in physical therapy or exercises that were previously too painful.

How many neurolysis sessions are needed?

The number of treatment sessions needed for neurolysis of the sympathetic plexus can vary depending on the specific condition, the patient’s response to the initial procedure, and the technique used. Typically, neurolysis is considered a single procedure that aims to provide long-term pain relief. However, in some cases, the following might apply:

• Initial treatment: neurolysis of the sympathetic plexus is often performed as a single session designed to provide significant or complete relief from chronic pain.
• Assessment and follow-up: after the initial procedure, patients are usually assessed to determine the effectiveness of the treatment. This assessment helps in deciding whether additional interventions are necessary.
• Possible repeat procedures: for some patients, the pain relief provided by neurolysis may diminish over time, or the initial treatment may not achieve the desired level of pain reduction. The procedure might be repeated to enhance or prolong the pain relief effect in such cases.

Complementary treatments: while neurolysis aims to provide significant pain relief, it may be part of a broader pain management strategy that includes other treatments like physical therapy, medication management, or additional pain relief procedures.