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

Abstract

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.