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Neurosurgical Interventions for the Control of Chronic Pain Conditions

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Handbook of Pain and Palliative Care

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Abstract

The neurosurgeon is uniquely suited to provide a wide variety of interventions for patients who suffer from chronic and intractable pain that cannot be appropriately managed with systemic opioid or other analgesics. The intraspinal pump is the most common neurosurgical approach to pain management. These pumps deliver analgesics directly into the cerebrospinal fluid, thereby providing significant relief of pain while limiting systemic side-effects. Non-reversible (destructive) neurosurgical interventions for pain, including cordotomy, commissural myelotomy, dorsal root entry zone (DREZ) lesions, cingulotomy, and hypophysectomy are also well established and highly effective, but have a higher rate of complications as compared to most other pain interventions. Cordotomy is the most commonly employed of these neuroablative procedures, especially in patients with unilateral somatic pain and a relatively short life expectancy. In contrast, DREZ-lesioning is best suited for deafferentation pain arising from a brachial plexus injury. The newest and fastest growing neurosurgical approach to the treatment of chronic pain is neuromodulation, utilizing either spinal cord stimulation (SCS), or deep brain stimulation (DBS). These procedures use electrical impulses to modulate pain signaling within the dorsal column of the spinal cord or deep brain structures. Both procedures are reversible and appear to have less risk than traditional ablative interventions.

These authors contributed equally to this work

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  1. Department of Neurosurgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Brittany L. Adler MD, Mark Yarchoan MD & John R. Adler Jr. MD

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    Rhonda J. Moore

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Adler, B.L., Yarchoan, M., Adler, J.R. (2013). Neurosurgical Interventions for the Control of Chronic Pain Conditions. In: Moore, R.J. (eds) Handbook of Pain and Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1651-8_31

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