Quality of Life Research

, Volume 3, Supplement 1, pp S43–S49 | Cite as

The recurrence of pain after neurosurgical procedures

  • R. R. Tasker
Research Papers


Various reasons exist for the frequent failure of neurosurgical procedures to control pain. Three main classes of factors are involved in this failure—those relating to the surgeon and the surgery, those dependent on the disease, and those dependent on the nervous system itself. In the first class, technical and conceptual difficulties may explain the recurrence of pain after neurosurgery, including our incomplete understanding of the function of recognized pain pathways, the failure of the surgeon to apply known information, and technical limitations in our ability to carry out neurosurgery. Factors dependent upon the disease itself include alterations in the physical extent of the disease, and in the types of pain caused by it. Factors dependent on the nervous system include nerve and tract regeneration, changes in the anatomy of the CNS in response to both the disease and the neurosurgery, and, importantly, somatotopographic reorganization including the opening of alternative pathways.

Key words

Neurosurgery pain pathophysiology pain recurrence pain relief somatotopographic reorganization 


  1. 1.
    Loeser JD. Tic douloureux and atypical face pain. In: Wall PD, Melzack R (eds) Textbook of Pain 2nd edn Edinburgh: Churchill Livinstone, 1989: 535–543.Google Scholar
  2. 2.
    Apfelbaum RI. Surgical management of disorders of the lower cranial nerves In: Schmidek HH, Sweet WH (eds) Operative Neurosurgical Techniques. Indications, Methods, and Results. 2nd edn. Orlando: Grune and Stratton, 1988: 1097–1109.Google Scholar
  3. 3.
    Tasker RR. Percutaneous cordotomy. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical Techniques. Indications, Methods, and Results. 2nd edn. Orlando: Grune and Stratton, 1988: 1191–1205.Google Scholar
  4. 4.
    Bosch DA. Stereotactic rostral mesencephalotomy in cancer pain and deafferentation pain—a series of 40 cases with follow-up results. J Neurosurg 1991; 75: 747–751.Google Scholar
  5. 5.
    North RB, Kidd DH, Zahurak M, James CS, Long DM. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 1993; 32: 384–395.Google Scholar
  6. 6.
    Levy RM, Lamb S, Adams JE. Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature. Neurosurgery 1987; 21: 885–893.Google Scholar
  7. 7.
    Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971–979.Google Scholar
  8. 8.
    Willis WD. The pain system. The neural basis of nociceptive transmission. In: Gildenberg PL (ed.) The Mammalian Nervous System Pain and Headache, Vol. 8. Basel: Karger, 1985: 276.Google Scholar
  9. 9.
    Mayer DJ, Price PD. Central nervous system mechanisms of analgesia. Pain 1976; 2: 379–404.Google Scholar
  10. 10.
    Tasker RR, de Carvalho GTC, Dolan EJ. Intractable pain of spinal cord origin: clinical features and implications for surgery. J Neurosurg 1992; 77: 373–378.Google Scholar
  11. 11.
    Noordenbos W, Wall PD. Diverse sensory functions with an almost totally divided spinal cord. A case of spinal cord transection with preservation of part of one anterolateral quadrant. Pain 1976; 2: 185–195.Google Scholar
  12. 12.
    Nashold BS, Wilson WP, Slaughter DG. Sensations evoked by stimulation in the midbrain of man. J Neurosurg 1969; 30: 14–24.Google Scholar
  13. 13.
    Bowsher D. Les relais de sensibilités somesthétiques et douloureuses au niveau du tronc cérébral et du thalamus. Toulouse Med 1963; 64: 965–983.Google Scholar
  14. 14.
    Glees P, Bailey RA. Course and relations of spinothalamic tract in man. Acta Psychiat Neurol Scand 1951; 74 (Suppl.): 199–206.Google Scholar
  15. 15.
    Noordenbos W. Remarks on afferent systems in the anterolateral quadrant. In: Janzen R, Keidel WD, Herz A, Steichete C (eds) Pain Basic Principles-Pharmacology—Therapy Stuttgart: Thieme/London: Churchill Livingstone, 1972: 112–115.Google Scholar
  16. 16.
    Wall PD. The design of experimental studies in the future development of restorative neurology of altered sensation and pain In: Dimitrijevic MR et al. (eds) Recent Achievements in Restorative Neurology 3 Altered Sensation on Pain. Basel: Karger, 1990: 197–205.Google Scholar
  17. 17.
    Richardson DE, Akil H. Pain reduction by electrical brain stimulation in man. Part II. Chronic self-administration in the periventricular grey matter. J Neurosurg 1977; 47: 184–194.Google Scholar
  18. 18.
    Young RF, Kroening R, Fulton W, Feldman RA, Chambi I. Electrical stimulation of the brain in treatment of chronic pain: experience over 5 years. Neurosurgery 1985 62: 389–396.Google Scholar
  19. 19.
    Willis WD. The pain system. The neural basis of nociceptive transmission. In: Gildenberg PL (ed) The Mammalian Nervous System. Pain and Headache. vol 8 Basel Karger 1985: 196–206.Google Scholar
  20. 20.
    Tasker RR. The problem of deafferentation pain in the management of the patient with cancer. J Palliat Care 1987; 2: 8–12.Google Scholar
  21. 21.
    Gildenberg PL. Stereotactic treatment of head and neck pain. Res Clin Stud Headache 1978; 5: 102–121.Google Scholar
  22. 22.
    Tasker RR, Dostrovsky JO, Parrent AG et al. Stroke-induced central pain pathophysiology. Poster presentation AANS Boston April 1993.Google Scholar
  23. 23.
    King RB. Pain and tryptophan. J Neurosurg 1980; 53: 44–52.Google Scholar
  24. 24.
    Noordenbos W. Pain. Amsterdam: Elsevier, 1959.Google Scholar
  25. 25.
    Hosobuchi Y. The majority of unmyelinated afferent axons in human ventral roots probably conduct pain. Pain 1980; 8: 167–180.Google Scholar
  26. 26.
    Smith FP. Trans-spinal ganglionectomy for relief of intercostal pain. J Neurosurg 1970; 32: 574–577.Google Scholar
  27. 27.
    Tasker RR, Dostrovsky JO. Deafferentation and central pain. In: Wall PD, Melzack R (eds) Textbook of Pain. 2nd edn. Edinburgh: Churchill Livingstone, 1989: 154–180.Google Scholar
  28. 28.
    Zimmermann M. Peripheral and central nervous mechanisms of nociception, pain, and pain therapy: facts and hypotheses. In: Bonica JJ, Liebeskind JC, Albe-Fessard DG (eds) Advances in Pain Research and Therapy, vol 3. New York: Raven, 1979: 3–32.Google Scholar
  29. 29.
    Gorecki J, Hirayama T, Dostrovsky JO, Tasker RR, Lenz FA. Thalamic stimulation and recording in patients with deafferentation and central pain. Stereotact Funct Neurosurg 1989; 52: 219–226.Google Scholar
  30. 30.
    Lenz FA, Tasker RR, Dostrovsky JO et al. Abnormal single-unit activity recorded in the somatosensory thalamus of a quadriplegic patient with central pain. Pain 1987; 31: 225–236.Google Scholar
  31. 31.
    Bowsher D. Contralateral mirror-image pain following anterolateral cordotomy. Pain 1988; 33: 63–65.Google Scholar
  32. 32.
    Nathan PW. Reference of sensation at the spinal level. J Neurol Neurosurg Psychiat 1956; 19: 88–100.Google Scholar
  33. 33.
    Nagara T, Kimura S, Arai T. A mechanism of new pain following cordotomy; reference of sensation. Pain 1987; 30: 89–91.Google Scholar
  34. 34.
    Nagara T, Amakawa K, Kumura S, Arai T. Reference of pain following percutaneous cervical cordotomy. Pain 1993; 53: 205–211.Google Scholar
  35. 35.
    Wall PD. The placebo effect: an unpopular topic. Pain 1992; 51: 1–3.Google Scholar
  36. 36.
    Cassinari V, Pagni CA. Central Pain: a Neurosurgical Survey Cambridge: Harvard, 1969.Google Scholar
  37. 37.
    Tasker RR. Identification of pain processing systems by electrical stimulation of the brain. Hum Neurobiol 1982; 1: 261–272.Google Scholar
  38. 38.
    Thrush DC. Congenital insensitivity to pain. A clinical, genetic and neurophysiological study of four children from the same family. Brain 1973; 96: 369–386.Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd 1994

Authors and Affiliations

  • R. R. Tasker
    • 1
  1. 1.Department of SurgeryThe Toronto Hospital, University of TorontoTorontoCanada

Personalised recommendations