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Chronic Abdominal Pain pp 239–244Cite as

Neurosurgical Options for Control of Chronic and Malignant Abdominal Pain

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Abstract

Neurosurgical treatment for chronic abdominal pain ranges from destructive spinal cord lesioning to ablate the ascending pain pathways to nondestructive therapies with the use of opioid pumps and electrical stimulation. Existence of unwanted side effects, socioeconomic factors, and the cost of long-term treatment, sometimes make opioid and neurostimulation therapies not feasible for the management of such pain. Consequently, destructive neurosurgical interventions may become the best option to manage chronic and malignant abdominal pain refractory to other treatment modalities. Although destruction of the thalamic nuclei was frequently performed decades ago for treatment of intractable pain, this approach is rarely used today, mainly due to advancements made in the surgeon’s ability to create targeted lesions within the spinal cord. The targets of such therapy are the spinothalamic tracts in the ventral spinal cord as well as another ascending pain pathway located in the center and dorsal midline of the spinal cord. Both of these locations are easily accessible and extremely amenable to procedures such as anterolateral cordotomy, commissurotomy, and midline myelotomy. While considered the last resort for the management of intractable abdominal pain, neuroablative procedures provide permanent pain relief with minimal side effects and low morbidity to those patients who have otherwise run out of treatment options.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, M/C 799, Rm 451 N NPI, Chicago, IL, 60612, USA

    Daniel M. Birk M.D., Matthew K. Tobin B.S. & Konstantin V. Slavin M.D.

Authors
  1. Daniel M. Birk M.D.
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  2. Matthew K. Tobin B.S.
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  3. Konstantin V. Slavin M.D.
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Correspondence to Konstantin V. Slavin M.D. .

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Editors and Affiliations

  1. Medical Director, Carolinas Pain Institute and Clinical Research Center, Professor of Anesthesiology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA

    Leonardo Kapural

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Birk, D.M., Tobin, M.K., Slavin, K.V. (2015). Neurosurgical Options for Control of Chronic and Malignant Abdominal Pain. In: Kapural, L. (eds) Chronic Abdominal Pain. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1992-5_24

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  • DOI: https://doi.org/10.1007/978-1-4939-1992-5_24

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1991-8

  • Online ISBN: 978-1-4939-1992-5

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