Neurolytic block

Thank you so much for reaching out to us at Macmillan. My name is Gail, and I’m one of the Cancer Information Nurse Specialists on the Macmillan Support Line.

I’m so sorry to hear about your dad’s diagnosis I’m truly sorry to hear how much your brother is going through — and how hard this must be for you, watching him cope with such difficult symptoms. It’s completely understandable that you want to make sure everything possible is being done to help manage his pain and protect his wellbeing. Please know you are not facing this alone — we’re here to support you both in any way we can.

From what you’ve described — particularly his severe pain, loss of bladder and bowel control, and nerve involvement in the sacrum — I wanted to gently highlight the importance of reviewing him for possible Malignant Spinal Cord Compression (MSCC). This is considered a medical emergency under NHS guidelines. Even if some nerve damage is thought to be irreversible, any worsening pain, new symptoms, or changes in mobility should always prompt urgent reassessment.

To protect the spinal cord from further damage, NHS advice recommends your brother sits or lies comfortably with support, avoids unnecessary movement or strain on his spine, and seeks immediate advice from his cancer team, GP, or NHS 111 — clearly mentioning that MSCC is suspected. You may find the information in the links helpful in understanding why urgent action is so important.

Of course, if your brother chooses not to pursue further investigations or treatment, that is entirely his choice and will always be respected. But it’s important that any decision is made with full information — particularly as treatments like steroids or even a single dose of radiotherapy may help reduce spinal pressure, protect remaining function, and relieve pain.

I also want to acknowledge how proactive you’ve been in asking about neurolytic nerve blocks. It’s clear how much you’re doing to explore every possible option for his comfort. Nerve blocks are sometimes used when pain isn’t well controlled by standard medications like opioids or intrathecal pumps. They’re very specialised procedures, typically considered by pain consultants or palliative care specialists after a thorough assessment of risks and potential benefits.

Nerve blocks tend to be most effective when the pain is coming from a specific nerve or plexus, rather than widespread nerve involvement. Because your brother already has significant nerve loss — including bowel, bladder, and leg function — there’s always a careful balance of risk. However, if these losses are considered irreversible, a specialist may still consider a nerve block appropriate.

Other important factors include his overall health, risk of bleeding, and whether the pain is mainly nerve related. Sometimes, other treatments — such as spinal cord stimulation, nerve-targeted medications, or radiotherapy — are considered instead of, or alongside, nerve blocks. You may find this Cancer Research UK guide to nerve blocks useful if you’d like to read more.

While I’m not certain what pain relief your brother is currently on, it’s worth remembering that medications like codeine or morphine work well for general pain but don’t always target nerve pain effectively. Drugs such as amitriptyline, gabapentin, and pregabalin are often prescribed for nerve pain and may be worth discussing with his GP if they haven’t yet been tried.

Decisions about more complex pain control — particularly nerve blocks — are usually best guided by a palliative care team. If your brother already has palliative care support, they’ll be the best people to help. If not, I would really encourage asking his GP for an urgent referral. It might be reassuring to know that palliative care is not only for end-of-life care — it’s about improving quality of life, managing complex symptoms, and supporting patients and families at any stage of illness.

Finally, I want to gently remind you that Macmillan is here for both you and your brother.   We offer a range of support — whether through our Support Line on 0808 808 00 00 (open every day, 8am–8pm), our live webchat, local Macmillan services, or our online community — a safe place where people in similar situations connect and support one another. We can also help you explore whether other charities or organisations may be able to offer further support.

Please don’t hesitate to get in touch again with any questions — even if it’s just for a listening ear. You are not alone in this. If it would help, I’d be more than happy to assist you with questions for his healthcare team or suggest key points you may want to raise.

We completely understand if using this platform feels easier for you. However, as responses here can sometimes take up to 48 hours, I’d really encourage you to reach out to us via the Macmillan Support Line or live webchat, where you can speak directly with a nurse or adviser in real time. This can be especially important when your brother is experiencing worsening symptoms or needs an urgent review of his pain.

Please don’t hesitate to get in touch again — even if it’s just for a listening ear. I’d be more than happy to help you draft questions for his healthcare team or suggest points you may want to raise.

We’re thinking of you and your brother at what I know must be such a difficult time.

Warmest wishes,

Gail
Cancer Information Nurse Specialist
Macmillan Cancer Support

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