Interventional Nerve Procedures for Pain Related to Head-and-Neck Cancer: A Systematic Review.

Abstract

To systematically review the evidence on the use of peripheral nerve interventions, including anaesthetic blocks, neurolysis and radiofrequency techniques, for the management of cancer-related pain in patients with head-and-neck malignancies. The review aimed to assess their clinical efficacy, access routes, safety profiles and associated complications. This systematic review was registered in PROSPERO (CRD42024564969) and conducted according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comprehensive search was performed in PubMed, Embase and the Cochrane Library through July 2024. Included studies evaluated peripheral nerve interventions in head-and-neck cancer (HNC) patients reporting at least one predefined outcome. Data on pain relief, duration of effect, medication use and adverse events were extracted. Risk of bias (ROB) was assessed using the Joanna Briggs Institute tools and ROB 2, depending on study design. Twenty-eight studies involving 536 patients were included. Of these, 298 received anaesthetic nerve blocks, 74 underwent neurolytic procedures, and 164 were treated with radiofrequency-based interventions. Sphenopalatine ganglion block and glossopharyngeal nerve block were the most frequently reported anaesthetic techniques, both demonstrating good efficacy and favourable safety profiles. Neurolytic procedures targeting superficial nerves (e.g., sphenopalatine, occipital, auriculotemporal) were generally effective and well tolerated. Neurolysis of the glossopharyngeal nerve showed promising results but was associated with greater anatomical risk and limited safety data. Pulsed and thermal radiofrequency (PRF/TRF) targeting the glossopharyngeal and trigeminal nerves were effective, with PRF showing a better safety profile. TRF was associated with transient dysphagia, sensory changes and reduced gag reflex. No major complications were reported across studies. However, outcomes and techniques varied widely, and most studies were case reports or small case series, often with a high ROB. Peripheral nerve interventions, particularly sphenopalatine and glossopharyngeal blocks, may be effective and safe options for pain management in HNC patients. Larger, high-quality trials are needed to confirm these findings and support broader clinical use.