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Current views on the role of neurosurgery for pain relief

  • Chapter
The Therapy of Pain

Part of the book series: Current Status of Modern Therapy ((CSMT,volume 6))

Abstract

There has recently been a gradual re-awakening of the interest of neurosurgeons in the management of intractable pain. With notable exceptions neurosurgical involvement declined during the period when the only effective treatment for intractable pain appeared to be two simple and well established techniques; cordotomy and retrogasserian trigeminal rhizotomy. Even these were not without complications and it is possible that advances in other techniques, such as microsurgery, attracted attention away from what must often have seemed unrewarding exercises. The tendency for pain recurrence was often viewed as inevitable and the development of new procedures viewed against a background of therapeutic nihilism. Much of this depression was related to the concept of ‘pain pathways’. Earlier generations had felt secure in performing sections and re-sections based on the anatomical and physiological knowledge available at that time. Gradually experience showed that these pathways were less clearly defined and less dominant than had been expected. Keller1 summarizing the development of our concepts of central pathways concluded that the evidence indicated that central pain pathways include both neo- and paleospinothalamic systems as well as the brain stem reticular formation. One of the most intractable pain syndromes is central pain and Cassinari and Pagni2 reviewing the evidence presented a strong case for invoking polysynaptic systems as the cause. Over the past decade therefore much attention has been given to producing lesions in various parts of this system with varying degrees of success. The encouragement given by research into the development of new procedures is reflected in the rise and fall of particular techniques as support for novel neurophysiological concepts waxes and wanes.

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  1. E. Hitchcock
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  1. Regional Pain Relief Centre, Hope Hospital, University of Manchester School of Medicine, Eccles Old Road, Salford, M6 8HD, England

    Mark Swerdlow (Consultant) (Consultant)

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Hitchcock, E. (1981). Current views on the role of neurosurgery for pain relief. In: Swerdlow, M. (eds) The Therapy of Pain. Current Status of Modern Therapy, vol 6. Springer, Dordrecht. https://doi.org/10.1007/978-94-010-9879-3_6

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  • DOI: https://doi.org/10.1007/978-94-010-9879-3_6

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