Neurolysis

Injections of neurolytic agents to destroy nervesand interrupt pain pathways have been used for manyyears.[13-16] The results of such injections are essentiallythe same as nerve sectioning, although the effect isusually seen for only 3 to 6 months. The use of neurolysishas decreased significantly in recent years dueto advances in spinal analgesia and increased lifeexpectancies in patients with cancer. However, neurolysisis still an attractive option for pain control inmany cancer patients. Neurolysis is indicated inpatients with severe, intractable pain in whom lessaggressive maneuvers are ineffective or intolerablebecause of either poor physical condition or the development of side effects. Another consideration isthat the painful area has responded to diagnosticblockade with a local anesthetic. An example inwhich a trial injection is useful is in areas where painis limited to a very circumscribed section, such as ribinvasion/metastases treated with intercostal neurolysis.In this case, the procedure is a relatively minorone and the benefit obtained may be significant. Theduration and quality of life are significant considerationssince the goal of neurolysis (analgesia) may produceundesirable side effects, including sphincterweakness and limb paralysis. In most but not all cases,these are unacceptable complications. Neurolysisrarely is permanent, and pain returns either from aregrowth of neural structures or by progression of theunderlying disease beyond the treated area.

Neurolysis may be chemical, thermic, or surgical.Today, chemical neurolysis today is generally limited toalcohol or phenol.

Alcohol is popular due to its ready access usingconcentrations of 50% to 100%. Due to its greater incidenceof dysesthesia, it may be more appropriate inblocking sympathetic nerve fibers or when lifeexpectancy is short. The incidence of painful dysesthesiasincreases significantly when alcohol injections aredone with myelinated nerve fibers; therefore, that practiceshould be avoided. Alcohol is a painful injectionthat spreads readily due to its low viscosity. One scenariowhere alcohol is commonly used and has a veryfavorable risk:benefit ratio is in celiac plexus neurolysisfor pancreatic and upper abdominal neoplasms. Therisk of paralysis is exceedingly rare (and is reversible,when using 50% alcohol). The response rates of 65% to85%[17] makes this a valuable adjunct in the managementof selected patients with abdominal pain.

Phenol is commonly used in concentrations of 7%to 12%. It has a reversible local anesthetic effect atconcentrations under 7%, which renders it essentiallyuseless for long-term analgesia at those lower concentrations.It has a greater affinity for vascular tissue thandoes alcohol, making it a less attractive choice withmajor vessels in the immediate area and large amountsof neurolytic agents are being injected (eg, celiacplexus blockade). Compared with alcohol, phenol ismuch less painful on injection. A hospital pharmacistgenerally prepares it, as it is not available as a ready-to-usepharmaceutical preparation. It is highly soluble inglycerin and is commonly mixed in a glycerin preparation.The advantage of mixing with glycerin is that itdiffuses slowly and infiltrates less, giving a more concentratedarea of coverage and thus decreasing spreadto unintended areas. Phenol has been prepared in sterilewater, normal saline, diatrizoate meglumine(Renografin), and metrizamide to guide its spread fluoroscopicallyduring injection. All aqueous phenol solutionsappear to be far more potent than those preparedin glycerin. Since phenol is hyperbaric, it willsettle if injected into a liquid medium such as the cerebrospinalfluid-containing subarachnoid space. Positioningis critical in this regard. The patient needs tobe placed face up, affected side down at a 45º angle sothat the neurolytic medication settles near the posteriorsensory rootlets. Since alcohol is hypobaric withrespect to cerebrospinal fluid, the patient is placed inthe opposite position (ie, face down, affected side upat a 45º angle).

The use of neurolytic agents for peripheral nerveneurolysis has great potential for benefit. In the caseof rib metastases, it is a simple procedure to inject 2mL of 7% to 10% phenol at three to four levels to controlpain. Similarly, in pelvic/perineal recurrences,injection of sacral nerves is a relatively simple procedurethat can be used for perineal pain after abdominalperineal resection (S4-S5) or pain emanating fromrectal

The "Botox Penectomy" could make a great story. Imagine if it were done to someone while they were passed out and didn't know what was going on? Maybe by a wife, lover or best friend that has held a grudge for years? What would the effect be if you didnt KNOW that the effect would wear off in 4 or 5 months?

Grab a brown recluse and throw it on, necrosis will do it too...

Ugh that would hurt.

Love to have mine gone though!

I have been receiving botox injections in the bladder neck to quell bladder spasms. I'm not sure of the dosage used, but the stuff needs to be re-injected every 4 months or so. I've been getting the injections for about 3 years now, and nothing permanent. From what my urologist tells me, she has had a few requests for botox injections to induce incontinence, but didn't mention anything about inducing impotence. From what she explained, botox works on muscle tissue (sphincter/bladder), and I'm not quite sure what it would do to erectile tissue.

Tclosetgirl (imported) wrote: Fri Apr 25, 2008 6:42 pm Grab a brown recluse and throw it on, necrosis will do it too...

Ugh that would hurt.

Love to have mine gone though!

From what I have witnessed, the brown recluse is by far the ver worst type of spider bite that you could ever have.

DO NOT TRY THIS AT HOME. OR ANYWHERE ELSE.

For the ultimate in quick 'n easy removal dip your penis in liquid nitrogen. You may then use a hammer to remove it and, you'll find, it's self-cauterizing. That said, anything even slightly touching the liquid-a finger, a ball etc.-would also be frozen solid on a permanent basis. This is NOT a good idea but it's a rash alternative that is as truly permanent as any other solution. What the subsequent medical consequences might be I cannot say but it's an easy guess that going to the Emergency Room with your "explanation" is quite likely to lead you into a meeting-perhaps several-with those of a psychiatric bent.