Phenol Neurolysis in Pain and Palliative Medicine.

Abstract

BACKGROUND: Pain is a common symptom in palliative care and affects patients' quality of life considerably. Standard analgesics are sometimes insufficient and are associated with substantial side effects. Neurolysis, the targeted destruction of nerves using thermal or chemical agents, offers an additional option for managing localized pain in palliative care. Phenol, a widely available chemical neurolytic agent known for its painless injection and hyperbaric properties when dissolved in glycerin, can effectively relieve refractory cancer pain. METHODS: A literature review was conducted on the pharmacology, toxicology, and indications of phenol in interventional pain and palliative medicine. RESULTS: Despite its use as a neurolytic agent for nearly a century, our current understanding of phenol's pharmacological properties, toxicity, and efficacy stems mainly from case series and small studies, often published decades ago. To date, no uniform guidelines exist, nor is there consensus on the optimal application of phenol in clinical practice, resulting in variability among practitioners. Chronic pain syndromes affect up to 30% of the global population, prompting the expansion of phenol neurolysis to new applications, such as joint denervation and sympathetic blocks in non-cancer pain. Understanding the mechanism of action of phenol and standardizing its clinical use are crucial for integrating this technique into broader pain management strategies. CONCLUSION: This review provides a comprehensive overview of the mechanisms, indications, benefits, and safety of phenol neurolysis in pain and palliative medicine, aiming to support its evidence-based use in clinical practice.