475: COMPARISON OF RADIOFREQUENCY ABLATION VERSUS CHEMICAL NEUROLYSIS OF THE SPLANCHNIC NERVES

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic cancer related pain, Pharmacological treatments, Treatment/management

Background and Aims: Chronic upper abdominal pain, particularly arising from malignancies, represents a major therapeutic challenge due to its intensity, refractory nature, and complex visceral pathways. Interventional treatments targeting splanchnic nerves have become a cornerstone of management when pharmacological therapy fails. Among the available modalities, chemical (Phenol) neurolysis and radiofrequency ablation (RFA) are widely used, yet evidence comparing their efficacy remains limited. This study aimed to compare analgesic efficacy, functional status improvement, sleep quality, and analgesic burden following RFA versus phenol neurolysis.

Methods: In this single‑blinded, parallel‑arm randomised controlled trial conducted over 18 months, 50 adults with chronic upper abdominal visceral pain (NRS ≥4 for >3 months) refractory to optimal medical therapy were randomly allocated into two groups: Group Phenol (6% phenol neurolysis at T11 bilaterally) and Group RFA (thermal RFA at 85°C at T10–T11). Standardised fluoroscopic techniques were utilised. Outcomes were measured at baseline, 7 days, 1 month, and 3 months. The primary outcome changes in the Numerical Rating Scale (NRS). Secondary outcomes included changes in Karnofsky Performance Status (KPS), Pittsburgh Sleep Quality Index (PSQI), and Medication Quantification Scale (MQS).

Results: All enrolled participants completed the study. Both interventions produced significant pain reduction in 7 days. However, RFA demonstrated superior analgesic durability, with significantly lower NRS values at 1 and 3 months (p<0.001). Functional improvement measured through KPS was significantly greater in the RFA group across all follow‑ups. Improvements in sleep quality and reductions in medication burden were also significantly superior following RFA. No major complications occurred in either group, and minor adverse events were self‑limiting.

Conclusions: Radiofrequency ablation provided more sustained analgesia, superior functional improvement, and greater reduction in analgesic use compared with phenol neurolysis. RFA may be preferred when resources permit, while phenol neurolysis remains a feasible alternative in settings with limited infrastructure.

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Presenting Author: Praveen Talawar
Submitting Author: PRAVEEN TALAWAR

Senior Author: Shridhar M

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Shridhar M: DM (Pain Medicine) - All India Institute of Medical Sciences, Rishikesh
• Ajit Kumar: NA - All India Institute of Medical Sciences, Rishikesh
• Ruma Thakuria: NA - All India Institute of Medical Sciences, Rishikesh