Neurosurgical Interventions for Chronic Pain
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.
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.
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.
KeywordsPain Surgery Neuromodulation Spinal cord stimulation Motor cortex stimulation Deep brain stimulation DREZotomy
- Bouche, B., Manfiotto, M., Rigoard, P., Lemarie, J., Dix-Neuf, V., Lanteri-Minet, M., et al. (2017). Peripheral nerve stimulation of brachial plexus nerve roots and supra-scapular nerve for chronic refractory neuropathic pain of the upper limb. Neuromodulation, 20, 684–689.PubMedCrossRefPubMedCentralGoogle Scholar
- Deer, T., Mekhail, N., Pope, J., Krames, E., Leong, M., Levy, R., et al. (2014). The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: The neuromodulation appropriateness consensus committee. Neuromodulation, 17, 515–550.PubMedCrossRefPubMedCentralGoogle Scholar
- Deer, T., Pope, J., Benyamin, R., Vallejo, R., Friedman, A., Caraway, D., et al. (2016). Prospective, multicenter, randomized, double-blinded, partial crossover study to assess the safety and efficacy of the novel neuromodulation system in the treatment of patients with chronic pain of peripheral nerve origin. Neuromodulation, 19, 91–100.PubMedCrossRefPubMedCentralGoogle Scholar
- Deer, T., Slavin, K., Amirdelfan, K., North, R., Burton, A., Yearwood, T., et al. (2017a). Success using neuromodulation with BURST (SUNBURST) study: Results from a prospective, randomized controlled trial using a novel burst waveform. Neuromodulation, 21(1), 56–66.PubMedCrossRefPubMedCentralGoogle Scholar
- Deer, T., Levy, R., Kramer, J., Poree, L., Amirdelfan, K., Grigsby, E., et al. (2017b). Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: A randomized comparative trial. Pain, 158, 669–681.PubMedCrossRefPubMedCentralGoogle Scholar
- Fontaine, D., Hamani, C., & Lozano, A. (2008, November 7). Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: Critical review of the literature. Journal of Neurosurgery. [Epub ahead of print].Google Scholar
- Fontaine, D., Blond, S., Lucas, C., Regis, J., Donnet, A., Derrey, S., et al. (2017). Occipital nerve stimulation improves the quality of life in medically-intractable chronic cluster headache: Results of an observational prospective study. Cephalalgia, 37, 1173–1179.PubMedCrossRefPubMedCentralGoogle Scholar
- Gybels, J., Erdine, S., Maeyaert, J., Meyerson, B., Winkelmuller, W., Augustinsson, L., et al. (1998). Neuromodulation of pain. A consensus statement prepared in Brussels16-18 january 1998 by the following task force of the European Federation of IASP Chapters (EFIC). European Journal of Pain, 2, 203–209.PubMedCrossRefGoogle Scholar
- Kapural, L., Yu, C., Doust, M., Gliner, B., Vallejo, R., Sitzman, B., et al. (2016). Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: 24-month results from a multicenter, randomized, controlled pivotal trial. Neurosurgery, 79, 667–677.PubMedPubMedCentralCrossRefGoogle Scholar
- Kinfe, T., Pintea, B., Link, C., Roeske, S., Güresir, E., Güresir, Á., et al. (2016). High frequency (10 kHz) or burst spinal cord stimulation in failed back surgery syndrome patients with predominant back pain: Preliminary data from a prospective observational study. Neuromodulation, 19(3), 268–275.PubMedCrossRefPubMedCentralGoogle Scholar
- Kumar, K., Taylor, R., Jacques, L., Eldabe, S., Meglio, M., Molet, J., et al. (2007). Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain, 132, 179–188.PubMedCrossRefPubMedCentralGoogle Scholar
- Kumar, K., Taylor, R., Jacques, L., Eldabe, S., Meglio, M., Molet, J., et al. (2008). The effect of spinal cord stimulation in neuropathic pain are sustained: A 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery, 63, 762–770.PubMedCrossRefPubMedCentralGoogle Scholar
- Lahuerta, J., Bowsher, D., Lipton, S., & Buxton, P. (1994). Percutaneous cervical cordotomy: A review of 181 operations on 146 patients with a study on the location of “pain fibers” in the C-2 spinal cord segment of 29 cases. Journal of Neurosurgery, 80, 975–985.PubMedCrossRefPubMedCentralGoogle Scholar
- Leal, P., Barbier, C., Hermier, M., Souza, M., Cristino-Filho, G., & Sindou, M. (2014). Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes. Journal of Neurosurgery, 120, 1484–1495.PubMedCrossRefPubMedCentralGoogle Scholar
- Liem, L., Russo, M., Huygen, F., Van Buyten, J., Smet, I., Verrills, P., et al. (2013). A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain. Neuromodulation, 16, 471–482.PubMedCrossRefPubMedCentralGoogle Scholar
- Mazars, G., Merienne, L., & Cioloca, C. (1973). Intermittent analgesic thalamic stimulation. Preliminary note. Revue Neurologique (Paris), 128, 273–279.Google Scholar
- Namba, S., & Nishimoto, A. (1988). Stimulation of internal capsule, thalamic sensory nucleus and cerebral cortex inhibited deafferentation hyperactivity provoked after gasserian ganglionectomy in cat. Acta Neurochirurgica (Suppl), 42, 243–247.Google Scholar
- Roberts, D., & Pouratian, N. (2017). Stereotactic radiosurgery for the treatment of chronic intractable pain: A systematic review. Operative Neurosurgery, 13, 543–551.Google Scholar
- Silberstein, S., Dodick, D., Saper, J., Huh, B., Slavin, K., Sharan, A., et al. (2012). Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: Results from a randomized multiceter double blinded, controlled study. Cephalalgia, 32(16), 1165–1179.PubMedCrossRefPubMedCentralGoogle Scholar
- van Gorp, E., Teernstra, O., Gultuna, I., Hamm-Faber, T., Burger, K., Schapendonk, R., et al. (2016). Subcutaneous stimulation as ADD-ON therapy to spinal cord stimulation is effective in treating low back pain in patients with failed back surgery syndrome: A multicenter randomized controlled trial. Neuromodulation, 19, 171–178.PubMedCrossRefPubMedCentralGoogle Scholar
- Zakrzewska, J., & Akram, H. (2011). Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database of Systematic Reviews, 9, CD007312. https://doi.org/10.1002/ 14651858.CD007312.pub2.Google Scholar