Neurolytic Blockade and Miscellaneous Approaches

The value of local blockade in abdominal wall syndromes has been described before. Theoretically, interruption of the pain pathways should provide relief of other forms of abdominal pain as well. This has led to the development of various techniques, both for diagnostic and therapeutic purposes. Neurolytic techniques are valuable for certain subsets of patients, such as those with cancer. By contrast, their use for pain relief in nonneoplastic pain, such as chronic pancreatitis, is not routinely recommended because of low efficacy (s 50%) and the short duration of relief (around 2 months), even in those patients that initially respond. Anecdotal experience suggests a similar disappointing outcome with the use of these techniques in functional bowel pain.

Indwelling epidural and intrathecal access systems have been effectively used for some patients with intractable chronic pain and to deliver opiates and other drugs, such as clonidine and baclofen. A variety of electrical stimulation techniques, including peripheral (transcutaneous electrical nerve stimulation), spinal, and cerebral stimulations have been used for various somatic pain conditions, as well as for angina pectoris, with encouraging results. Acupressure is another alternative medicine technique that has been widely used for pain, with results that are mixed. However, none of these techniques have been well studied, if at all, in patients with abdominal pain.

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