Skip to main content
SpringerLink
Log in

Surgical Approaches to Chronic Pain

  • Chapter
  • First Online:
Fundamentals of Pain Medicine

  • 2342 Accesses

Abstract

The surgical treatment of chronic pain has evolved significantly over the last 50 years. Early treatments for intractable pain focused on selective lesioning of the pain pathways especially the spinothalamic tract. While these techniques have fallen out of favor, they are still used in some cases to manage cancer pain. The discovery that electrical stimulation or intraspinal drug infusions can predictably and safely control pain revolutionized the treatment of patients who had few pharmacological options. Spinal cord stimulation is an effective way to augment other pain therapies especially for patients with failed back surgery syndrome and complex regional pain syndrome. Deep brain stimulation and motor cortex stimulation are other options of last resort for refractory pain. Continuous infusion of intrathecal medication via a programmable pump is another option in patients who do not respond to standard therapy. In patients who do not tolerate the side effects or who do not respond to medications for trigeminal neuralgia, microvascular decompression and percutaneous and stereotactic radiosurgery are options.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Armour D. Surgery of the spinal cord and its membranes. Lancet. 1927;1:691–7.

    Google Scholar 

  2. Foltz EL, White LE Jr. Pain “relief ” by frontal cingulumotomy. J Neurosurg. 1962;19(2):89–100.

    Google Scholar 

  3. Thomas DGT, Kitchen ND. Longterm followup of dorsal root entry zone lesions in brachial plexus avulsion. J Neurol Neurosurg Psychiatry. 1994;57:737–8.

    Google Scholar 

Suggested Reading

  1. Boccard SGJ, Pereira EAC, Aziz TZ, Green AL. Long-term outcomes of deep brain stimulation for neuropathic pain. Neurosurgery. 2013;72:221–31.

    Article  PubMed  Google Scholar 

  2. Broggi G, Broggi M, Ferroli P, Frnazini A. Surgical technique for trigeminal microvascular decompression. Acta Neurochir. 2012;154:1089–95.

    Article  PubMed  Google Scholar 

  3. Cheng JS, Lim DA, Chang EF, Barbaro NM. A review of percutaneous treatments for trigeminal neuralgia. Oper Neurosurg. 2013;10(1):25–33.

    Article  Google Scholar 

  4. Kanapolat Y, Ugur HC, Ayten M, Elhan AH. Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy. Neurosurgery. 2009;64(3):187–94.

    Google Scholar 

  5. Kemler MA, Barendse GAM, van Kleef M, de Vet HCW, Rijks CPM, Furnée CA, van den Wildenberg FAJM. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343(9):618–24.

    Article  CAS  PubMed  Google Scholar 

  6. Kumar K, Hunter G, Demeria DD. Treatment of chronic pain by using intrathecal drug therapy compared with conventional pain therapies: a cost-effectiveness analysis. J Neurosurg. 2002;97(4):803–10.

    Article  PubMed  Google Scholar 

  7. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomized controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1–2):179–88.

    Article  PubMed  Google Scholar 

  8. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98–1067.

    Article  PubMed  Google Scholar 

  9. Raslan AM, Cetas JS, McCartney S, Burchiel KJ. Destructive procedures for control of cancer pain: the case for cordotomy. J Neurosurg. 2011;114:155–70.

    Article  PubMed  Google Scholar 

  10. Sindou MP, Blondet E, Emery E, Mertens P. Microsurgical lesioning in the dorsal root entry zone for pain due to brachial plexus avulsions: a prospective series in 55 patients. J Neurosurg. 2005;112(6):1018–28.

    Article  Google Scholar 

  11. Smith TJ, Staats PS, Deer T, Stearns LJ, Rauck RL, Boortz-Marx RL, Buchser E, Català E, Bryce DA, Coyne PJ, Pool GE. Implantable drug delivery systems study group randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–9.

    Article  CAS  PubMed  Google Scholar 

  12. Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain. Adv Stereotact Funct Neurosurg. 1991;52:137–9.

    CAS  Google Scholar 

  13. Viswanathan A, Burton AW, Rekito A, McCutcheon IE. Commisural myelotomy in the treatment of intractable visceral pain. Stereotact Funct Neurosurg. 2010;88:374–82.

    Article  PubMed  Google Scholar 

  14. Yen C, Shlesinger D, Sheehan JP. Gamma knife radiosurgery for trigeminal neuralgia. Expert Rev Med Devices. 2011;8(6):709–21.

    Article  PubMed  Google Scholar 

  15. Yen CP, Kung SS, Su YF, Lin WC, Howng SL. Stereotactic bilateral anterior cingulotomy for intractable pain. J Clin Neurosci. 2005;12(8):886–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA

    Sean J. Nagel MD & Andre G. Machado MD, PhD

  2. Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA

    Bryan S. Lee MD

  3. Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Andre G. Machado MD, PhD

Authors
  1. Sean J. Nagel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bryan S. Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andre G. Machado MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean J. Nagel MD .

Editor information

Editors and Affiliations

  1. Professor of Anesthesiology President-elect, American Academy of Pain Medicine, Director, Cleveland Clinic Multidisciplinary Pain Medicine Fellowship Program, Departments of Pain Management and Neurosciences, Cleveland Clinic Anesthesiology Institute and Lerner Research Institute, Cleveland, Ohio, USA

    Jianguo Cheng

  2. Chairman, Department Pain Management, Cleveland Clinic, Cleveland, Ohio, USA

    Richard W. Rosenquist

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Nagel, S.J., Lee, B.S., Machado, A.G. (2018). Surgical Approaches to Chronic Pain. In: Cheng, J., Rosenquist, R. (eds) Fundamentals of Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-64922-1_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64922-1_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64920-7

  • Online ISBN: 978-3-319-64922-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation