Chemical Neurolysis

areWhat is Chemical Neurolysis?

This is a chemical way to destroy the nerve that is causing the neuroma. Neuroma is like a pinched nerve that causes pain between the 3rd and the 4th toe. It may cause symptoms such as stabbing pain, numbness, burning sensation or tingling between the toes and on the ball of the foot.

How Does it work?

There are 7 injections ideally done every 7 days. The injection is a mixture of ethanol and a local anesthetic. The nerve absorbs the alcohol and eventually becomes poisoned by the mixture. After repeated injections, the nerve will die from being poisoned and the pain will disappear.

Is this Procedure New?

This procedure was very popular in the 1970’s then was not used much for no known reasons. Recently it has begun being used again to treat neuromas

Who Should Get the Procedure?

This procedure is recommended after some initial treatments have failed. Those may include suggestions such as icing the area or not wearing shoes that squash the toes. Try to take an anti-inflammatory such as ibuprofen. Also try reducing activity that causes the pain until the pain subsides.

You may even try getting fitted for special shoes that would reduce the pressure on the ball of your foot. If those preliminary treatments fail, the patient may try cortisone shots to the area to see if there is improvement. If that fails as well, the patient’s only alternative would be surgery. Chemical neurolysis is the last procedure to try before surgery is done to completely remove the nerve.

What is the Success Rate?

There is a 61% – 89% success rate if at least 5 sessions of injections have been completed. If injections were allowed every 7 days the success rate would be considerably higher but insurance companies insist on at least 10 days between injections. During that 10 days, the nerve naturally tried to heal itself so it naturally will take longer to die which is what is needed for the pain to go away.

Are there any Side Effects?

There may be some pain around the injection site for 2-3 days after the procedure. There may also be an increase in pain during the first 2-3 sessions. This is actually a good sign because it indicates that the nerve is responding to the injection. Eventually, the poison in the alcohol will cause the nerve to die.

What are the Advantages of Chemical Neurolysis over Surgery?

Surgery is the last resort to relieve the pain but there are drawbacks to the surgery. There is a chance of infection at the surgery site when you do surgery. There is no chance of infection from the injection procedure. The surgery also will cause you to not put any weight on the foot for an extended period of time. The injection procedure can be done on your lunch hour with no real problems resuming normal activities. Surgery also leaves a fairly long scar on the foot and the injection obviously leaves no scarring at all. Surgery is much more expensive also.

References

Fishman, Scott, Ballantyne, Jane, & Rathmell, James P. (2010). Bonica’s Management of Pain. Lippincott Williams & Wilkins. P. 1458

Mohamed, S. A., Ahmed, D. G., & Mohamad, M. F. (2013). Chemical neurolysis of the inferior hypogastric plexus for the treatment of cancer-related pelvic and perineal pain. Pain Research & Management: The Journal Of The Canadian Pain Society = Journal De La Société Canadienne Pour Le Traitement De La Douleur, 18(5), 249-252.