Contemporary concepts of pain surgery

Kim Burchiel, Ahmed M. Raslan

Research output: Contribution to journalReview article

Abstract

Pain surgery is one of the historic foundations of neurological surgery. The authors present a review of contemporary concepts in surgical pain management, with reference to past successes and failures, what has been learned as a subspecialty over the past 50 years, as well as a vision for current and future practice. This subspecialty confronts problems of cancer pain, nociceptive pain, and neuropathic pain. For noncancer pain, ablative procedures such as dorsal root entry zone lesions and rhizolysis for trigeminal neuralgia (TN) should continue to be practiced. Other procedures, such as medial thalamotomy, have not been proven effective and require continued study. Dorsal rhizotomy, dorsal root ganglionectomy, and neurotomy should probably be abandoned. For cancer pain, cordotomy is an important and underutilized method for pain control. Intrathecal opiate administration via an implantable system remains an important option for cancer pain management. While there are encouraging results in small case series, cingulotomy, hypophysectomy, and mesencephalotomy deserve further detailed analysis. Electrical neuromodulation is a rapidly changing discipline, and new methods such as high-frequency spinal cord stimulation (SCS), burst SCS, and dorsal root ganglion stimulation may or may not prove to be more effective than conventional SCS. Despite a history of failure, deep brain stimulation for pain may yet prove to be an effective therapy for specific pain conditions. Peripheral nerve stimulation for conditions such as occipital neuralgia and trigeminal neuropathic pain remains an option, although the quality of outcomes data is a challenge to these applications. Based on the evidence, motor cortex stimulation should be abandoned. TN is a mainstay of the surgical treatment of pain, particularly as new evidence and insights into TN emerge. Pain surgery will continue to build on this heritage, and restorative procedures will likely find a role in the armamentarium. The challenge for the future will be to acquire higher-level evidence to support the practice of surgical pain management.

Original languageEnglish (US)
Pages (from-to)1039-1049
Number of pages11
JournalJournal of neurosurgery
Volume130
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Spinal Cord Stimulation
Trigeminal Neuralgia
Pain
Pain Management
Spinal Nerve Roots
Neuralgia
Opiate Alkaloids
Cordotomy
Ganglionectomy
Rhizotomy
Nociceptive Pain
Hypophysectomy
Deep Brain Stimulation
Motor Cortex
Spinal Ganglia
Peripheral Nerves
Therapeutics
Cancer Pain

Keywords

  • Ablative surgery
  • Neuromodulation
  • Pain
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Contemporary concepts of pain surgery. / Burchiel, Kim; Raslan, Ahmed M.

In: Journal of neurosurgery, Vol. 130, No. 4, 01.04.2019, p. 1039-1049.

Research output: Contribution to journalReview article

Burchiel, Kim ; Raslan, Ahmed M. / Contemporary concepts of pain surgery. In: Journal of neurosurgery. 2019 ; Vol. 130, No. 4. pp. 1039-1049.
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