Percutaneous neurolysis in cancer patients (2026)
Description
Authors: D. Filippiadis and S. Bauones
Reviewers: I. Bargellini, J. Guirola, and R. Uberoi
This course corresponds to chapters 2.2.5.1 Fundamental IO, 2.2.5.3 Non-vascular interventional oncology and 2.2.5.3.4 Malignant musculoskeletal disease in the European Curriculum and Syllabus for Interventional Radiology.
Abstract
Cancer pain is multifactorial and can be associated with ongoing tissue damage (nociceptive type, otherwise called somatic or visceral) or damage/dysfunction in the nervous system (neuropathic type). When a neuropathic component is present, the resulting pain can be more difficult to treat and frequently fails systemic analgesia. Approximately 70% of cancer patients will report pain in any phase of the disease, and the vast majority of these patients are not adequately treated. Percutaneous neurolysis can be either chemical (via phenol or alcohol injection) or thermal (using Radiofrequency or cryoablation). In well-selected patients, pulsed radiofrequency aimed at neuromodulation may serve as an alternative. To properly select patients and the target of choice, thorough knowledge of nervous anatomy and pain transmission pathways is a prerequisite, along with image-guidance and strict sterility measures. In general, percutaneous neurolysis and neuromodulation are safe techniques which necessitate only minor peri-procedural provisions. In cases of cancer pain refractory to systemic therapies, percutaneous neurolysis and neuromodulation seem to be a feasible, reproducible, efficient and safe treatment for pain palliation.
Learning objectives
- To understand the pathophysiology of cancer-related nociceptive and neuropathic pain and the role of the sympathetic axis in pain transmission.
- To identify the indications, contraindications, advantages, and limitations of percutaneous neurolysis in oncologic patients.
- To understand the major targets for cancer pain treatment, including the stellate ganglion, coeliac plexus, splanchnic nerves, superior hypogastric plexus, ganglion impar, and selected peripheral neural targets.
- To compare chemical neurolysis, radiofrequency ablation, cryoneurolysis, and pulsed radiofrequency, including preferential use in different clinical scenarios.
- To understand procedural planning, image guidance, peri-procedural pain management, ablation protocols, complication avoidance, and follow-up.
- To review the contemporary evidence base and best-practice recommendations relevant to percutaneous neurolysis in cancer pain.
Further information
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapters 2.2.5.1 Fundamental IO, 2.2.5.3 Non-vascular interventional oncology and 2.2.5.3.4 Malignant musculoskeletal disease.
The format of the course is easy to use and interactive by including texts, graphics, videos and a quiz to support your learning. The course duration is around one and a half hours and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1.5 European CME credits (ECMEC). Please note that this course will be taken offline on October 08, 2031.
The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.
The enrolment period of this course is linked to the validity of the All-Access Pass.
Release date: October 2026
