A common question from patients with pain is whether someone can just cut the nerves that are causing pain or otherwise destroy them. There are a few cases where this is done, but it is limited since most nerves in the body carry motor and sensory functions and cutting them would leave a person weak wherever that nerve controls a muscle.

The loss of muscles would also produce pain or sometimes the nerve then short-circuits and becomes even more painful. This is common in amputations where the nerves that are cut cause odd pains and phantom sensations. However, there are some special situations where we can damage the ends of sensory nerves in isolation to treat certain types of pain.

Nerve Control and Pain

The most common times where nerve endings are purposefully destroyed are for facet joint pain. On each side of the spine at every level there is a joint between the bones known as the facet joint. In the cervical and lumbar levels they are very mobile, but they also support a significant amount of weight from our head and bodies. These joints are almost identical to your finger joints in size and function but they have significantly more weight going through them. Pain from these joints in the neck have well defined patterns for head, neck and upper back pain. This is also the typical pain seen in a whiplash type injury.

In the low back, the pain is usually just along the spine or into the buttock area. The thoracic region rarely produces joint pain due to the ribcage providing support and restricting motion. When facet pain is unresponsive to other conservative treatments like medications and physical therapy, blocking the medial branch nerve to the joint with anesthetic will determine if the joint is the cause of the symptoms. If it is successful, we can use a special needle and machine to create a microwave signal at the tip of a needle and cut the very end of the nerve away from the joint to relieve pain for about a year. Since this is the terminal end of the nerve and not its cell body, the nerve ending will regrow and re-innervate the joint.  

In the rest of the body there are very few safe places that only a sensory nerve travels separately from a motor nerve. For example, the knee joint is another place where doctors are trying to sever the sensory nerves. The technique is similar to the one used for the facet joints but the locations of the appropriate nerves are somewhat variable and a much larger lesion is needed to be successful, and it often only works for six months. There are other techniques for knee pain including the use of specialized hyaluronidase (rooster cone); a compound that stimulates joints to produce their own fluid. Another possible better treatment in the future will be the use of stem cell injections, since this may allow the joint to regrow more normal joint tissue. At this time it is not covered by insurance, is somewhat costly ($5,000/treatment) and is successful about 50% of the time.

Cutting Sensory Nerves

There are very limited other places and times when sensory nerves are attempted to be cut. Sometimes for rib pain or pelvic pain that does not respond to any other simpler management, the nerves can be frozen using a special machine. Localizing the nerves that cause this pain may be very difficult, and the success is around 50 percent. Pain relief again is about six months. In a few special circumstances, nerves are cut as part of surgery, like during amputation or certain reconstructive surgeries, especially after trauma. The problem with cutting nerves in amputations is phantom pain, where pain is felt by the brain in an area where a person no longer has an extremity.

Pain is a complex process that occurs in the body. Simply cutting a nerve to rid the body of pain usually causes more problems with pain and additional possibility of loss of muscle function. Nerves sometimes can be cut for certain types of spine joint pain, but there are very few other places in the body where a similar technique can be used successfully. If pain is a significant problem, asking a pain physician about the variety of options available for a particular issue may be the best plan.