Pulsed radiofrequency of S2-4 nerve roots vs ganglion impar neurolysis for severe perineal cancer pain

Pain Rep. 2026 Feb 11;11(2):e1393. doi: 10.1097/PR9.0000000000001393. eCollection 2026 Apr.

ABSTRACT

INTRODUCTION: Perianal and perineal-related cancer pain is deemed severe in most patients with cancer, and its management poses a significant challenge due to rich innervation of this region.

OBJECTIVES: This study compared the analgesic efficacy of bilateral selective pulsed radiofrequency (PRF) of sacral nerve roots (S2-S4) with ganglion impar neurolysis (GIN) in patients experiencing severe perianal and perineal cancer pain.

METHODS: Forty patients with severe perineal or perianal cancer pain, defined by a visual analogue scale (VAS) score ≥7, were randomized to 1 of 2 groups. Both procedures were performed under fluoroscopic guidance: the PRF group received bilateral selective PRF of sacral nerve roots (S2-S4), whereas the GIN group underwent ganglion impar neurolysis using a 6% phenol in saline injection. The primary outcome was the VAS score at 4 weeks.

RESULTS: Both groups showed significant reductions in VAS scores up to 12 weeks post-treatment compared to baseline (P < 0.001). The PRF group had significantly lower VAS scores than the GIN group at postanesthesia care unit, and at 1, 4, and 8 weeks (P < 0.05). Oxycodone and pregabalin consumption were lower in the PRF group at these intervals. The PRF group experienced a longer procedure duration and a higher incidence of injection site pain (P < 0.05). However, quality-of-life scores and patient satisfaction were significantly higher in the PRF group.

CONCLUSION: Bilateral PRF of sacral nerve roots (S2-S4) resulted in more analgesic efficacy and improved quality-of-life compared to GIN in patients with severe perineal and perianal cancer pain, despite higher rate of injection site discomfort.

PMID:41694550 | PMC:PMC12900185 | DOI:10.1097/PR9.0000000000001393