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Neurosurgical Interventions for Chronic Pain

  • Denys FontaineEmail author
Chapter

Abstract

Three kinds of neurosurgical techniques may be used to alleviate chronic medically intractable pain:
  1. 1.

    Lesional techniques to interrupt the transmission of nociceptive neural input by lesioning the nociceptive pathways (DREZotomy, cordotomy). They are indicated to treat morphine-resistant cancer pain and few cases of selected neuropathic pain.

     
  2. 2.

    Neuromodulation techniques to decrease pain by reinforcing inhibitory and/or to limit activatory mechanisms. Chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation, etc.) is used to treat chronic neuropathic pain.

     
  3. 3.

    Intrathecal infusion of analgesics (morphine, ziconotide, etc.), using implantable pumps, to increase their efficacy and to reduce their side effects.

     

These techniques can improve, sometimes dramatically, selected patients with severe and chronic pain, refractory to all other treatments. The quality of the analgesic outcome depends mainly on the relevance of the indications and the understanding of the underlying mechanisms of pain.

Keywords

Pain Surgery Neuromodulation Spinal cord stimulation Motor cortex stimulation Deep brain stimulation DREZotomy 

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Authors and Affiliations

  1. 1.Department of NeurosurgeryCHU de Nice, Université Cote d’AzurNiceFrance
  2. 2.Université Cote d’Azur, FHU INOVPAIN, CHU de NiceNiceFrance

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