The second step in the chronic pain treatment steps includes procedures or treatments that are more invasive and costly.
Nerve Blocks. With nerve blocks, a local anesthetic and/or steroids are applied directly to the nerve causing the pain. Nerve blocks typically provide temporary relief of pain due to their numbing (anesthetic) effect. They also can help decrease the swelling of tissues around the nerve, which can irritate the nerve and result in pain.
Systemic Opioids. Powerful pain medications known as opioids are often prescribed when severe chronic pain does not respond to first-step therapies and when surgery is either not an option or has failed. Opioids are effective in relieving the most severe pain. However, side effects—ranging from drowsiness and constipation to an increased risk of addiction—are common, particularly when opioids are administered by pills or skin patches.
Neurolysis. With neurolysis, a chemical is used to destroy nerve tissue to stop a nerve from functioning. The chemical (usually alcohol or phenol) is injected around the specific spinal nerve that serves or activates the painful area. The goal of neurolysis is to stop the nerve from sending pain signals to the brain. This procedure is usually effective in relieving pain for weeks or months.
Thermal Procedures. Thermal procedures, such as cryoanalgesia and radio-frequency (RF) lesioning, use temperature to disrupt a nerve's ability to transmit pain signals. With cryoanalgesia, extreme cold is applied to a nerve. The length of time the nerve is exposed to the cold and the intensity of the exposure determine how much the nerve is affected. Nerve damage can be minimal, with loss of sensory function for several weeks, or full, with complete loss of sensory function and possible motor impairment. Cryoanalgesia is often used for chronic pain of the chest wall, face, and other neuralgias.
With RF lesioning, high-frequency energy is used to produce heat and thermal coagulation of affected nerves to disrupt the nerves' ability to transmit pain signals. The RF energy is directed only at the affected nerves, which minimizes the risk of damaging nerves and tissues next to the affected nerves. RF lesioning can provide pain relief for up to a year or more and is repeatable. Note: RF lesioning should not be confused with RF spinal cord stimulation, because they are different therapies.
