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The role of intrathecal neurolysis in the treatment of cancer-related perianal and perineal pain

Pain Clinic, Department of Anaesthesia, University Hospital, Cologne

Detlev Zech

Pain Clinic, Department of Anaesthesia, University Hospital, Cologne

Stefan Grond

Pain Clinic, Department of Anaesthesia, University Hospital, Cologne

In this study of intrathecal neurolysis with phenol in nine patients with perianal or perineal cancer-related pain, we found a short duration of pain relief (17.8 days) and a significant incidence of serious side effects, with two patients having permanent urinary retention. The average daily oral morphine dose could be reduced by approximately 20% during this time but in only two out of nine patients could opioids be stopped for a period of four weeks. Conventional analgesic pain treatment based on WHO guidelines remains of paramount importance in the treatment of cancer-related perianal pain, as does the prior utilization of other lower risk techniques before considering the use of intrathecal neurolysis (ITN). Intrathecal or epidural opiates may be a preferable technique for patients with pelvic or perineal pain, and intact bladder and/or bowel function. Improved patient selection, a better understanding of the pathophysiology of the underlying pain, and appropriate timing in performing ITN during the course of the disease may result in higher success rates.

Key Words: analgesia • neoplasms • nerve block • pain • subarachnoid space

Palliative Medicine, Vol. 6, No. 2, 140-145 (1992)
DOI: 10.1177/026921639200600208


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