Destructive procedures for control of cancer pain: The case for cordotomy: A review

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Abstract

Object. Historically, destructive procedures for cancer pain were the main line of treatment therapy. However, use of high-dose opioids has essentially replaced such procedures. Recognition of the limits of medical therapy to treat cancer pain effectively is growing, while conversely, in regions with limited access to pain medications, the importance of destructive surgical techniques is increasing. A critical evaluation of the evidence for destructive techniques is warranted, and the authors review current evidence underlying these procedures. Methods. A US National Library of Medicine PubMed search for "ablation," "DREZ," "dorsal root entry zone," "cingulotomy," "cordotomy," "ganglionectomy," "mesencephalotomy," "myelotomy," "neurotomy," "neurectomy," "rhizotomy," "sympathectomy," "thalamotomy," "tractotomy," and "pain" was undertaken. The search was then limited to human studies, English-language literature, cancer pain, and reports with more than 1 patient. Results. One hundred twenty papers were identified and reviewed based on the selection criteria described. According to the Canadian and US task forces, classification of clinical research literature only "sympathectomy" was supported by Class I or II studies, with 2 Class I papers and 1 Class II paper identified for cancer pain. All other procedures were supported by Class III studies of variable quality. Cordotomy in particular was the most extensively studied and reviewed procedure. Given the large number of patients studied, consistent results, multiplicity of reports and, even though evidence quality for individual studies was relatively low, cumulative evidence suggests that cordotomy may play an important role in the treatment of cancer pain. Conclusions. Destructive procedures for cancer pain may play more than a historic role in the management of cancer pain. Cumulative evidence from even the poorest quality studies suggests that some procedures, such as cordotomy, should be included in the armamentarium available to the neurosurgeon today. To renew appropriate interest in these procedures, evidence and studies that meets today's evidence-based research criteria are warranted.

Original languageEnglish (US)
Pages (from-to)155-170
Number of pages16
JournalJournal of Neurosurgery
Volume114
Issue number1
DOIs
StatePublished - Jan 2011

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Cordotomy
Sympathectomy
Ganglionectomy
Rhizotomy
National Library of Medicine (U.S.)
Cancer Pain
Pain
Spinal Nerve Roots
Advisory Committees
Therapeutics
Research
PubMed
Patient Selection
Opioid Analgesics
Language

Keywords

  • Ablative procedure
  • Cancer
  • Cordotomy
  • Destructive procedure
  • Myelotomy
  • Pain
  • Sympathectomy
  • Tractotomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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title = "Destructive procedures for control of cancer pain: The case for cordotomy: A review",
abstract = "Object. Historically, destructive procedures for cancer pain were the main line of treatment therapy. However, use of high-dose opioids has essentially replaced such procedures. Recognition of the limits of medical therapy to treat cancer pain effectively is growing, while conversely, in regions with limited access to pain medications, the importance of destructive surgical techniques is increasing. A critical evaluation of the evidence for destructive techniques is warranted, and the authors review current evidence underlying these procedures. Methods. A US National Library of Medicine PubMed search for {"}ablation,{"} {"}DREZ,{"} {"}dorsal root entry zone,{"} {"}cingulotomy,{"} {"}cordotomy,{"} {"}ganglionectomy,{"} {"}mesencephalotomy,{"} {"}myelotomy,{"} {"}neurotomy,{"} {"}neurectomy,{"} {"}rhizotomy,{"} {"}sympathectomy,{"} {"}thalamotomy,{"} {"}tractotomy,{"} and {"}pain{"} was undertaken. The search was then limited to human studies, English-language literature, cancer pain, and reports with more than 1 patient. Results. One hundred twenty papers were identified and reviewed based on the selection criteria described. According to the Canadian and US task forces, classification of clinical research literature only {"}sympathectomy{"} was supported by Class I or II studies, with 2 Class I papers and 1 Class II paper identified for cancer pain. All other procedures were supported by Class III studies of variable quality. Cordotomy in particular was the most extensively studied and reviewed procedure. Given the large number of patients studied, consistent results, multiplicity of reports and, even though evidence quality for individual studies was relatively low, cumulative evidence suggests that cordotomy may play an important role in the treatment of cancer pain. Conclusions. Destructive procedures for cancer pain may play more than a historic role in the management of cancer pain. Cumulative evidence from even the poorest quality studies suggests that some procedures, such as cordotomy, should be included in the armamentarium available to the neurosurgeon today. To renew appropriate interest in these procedures, evidence and studies that meets today's evidence-based research criteria are warranted.",
keywords = "Ablative procedure, Cancer, Cordotomy, Destructive procedure, Myelotomy, Pain, Sympathectomy, Tractotomy",
author = "Ahmed Raslan and Justin Cetas and Shirley McCartney and Kim Burchiel",
year = "2011",
month = "1",
doi = "10.3171/2010.6.JNS10119",
language = "English (US)",
volume = "114",
pages = "155--170",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
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T2 - The case for cordotomy: A review

AU - Raslan, Ahmed

AU - Cetas, Justin

AU - McCartney, Shirley

AU - Burchiel, Kim

PY - 2011/1

Y1 - 2011/1

N2 - Object. Historically, destructive procedures for cancer pain were the main line of treatment therapy. However, use of high-dose opioids has essentially replaced such procedures. Recognition of the limits of medical therapy to treat cancer pain effectively is growing, while conversely, in regions with limited access to pain medications, the importance of destructive surgical techniques is increasing. A critical evaluation of the evidence for destructive techniques is warranted, and the authors review current evidence underlying these procedures. Methods. A US National Library of Medicine PubMed search for "ablation," "DREZ," "dorsal root entry zone," "cingulotomy," "cordotomy," "ganglionectomy," "mesencephalotomy," "myelotomy," "neurotomy," "neurectomy," "rhizotomy," "sympathectomy," "thalamotomy," "tractotomy," and "pain" was undertaken. The search was then limited to human studies, English-language literature, cancer pain, and reports with more than 1 patient. Results. One hundred twenty papers were identified and reviewed based on the selection criteria described. According to the Canadian and US task forces, classification of clinical research literature only "sympathectomy" was supported by Class I or II studies, with 2 Class I papers and 1 Class II paper identified for cancer pain. All other procedures were supported by Class III studies of variable quality. Cordotomy in particular was the most extensively studied and reviewed procedure. Given the large number of patients studied, consistent results, multiplicity of reports and, even though evidence quality for individual studies was relatively low, cumulative evidence suggests that cordotomy may play an important role in the treatment of cancer pain. Conclusions. Destructive procedures for cancer pain may play more than a historic role in the management of cancer pain. Cumulative evidence from even the poorest quality studies suggests that some procedures, such as cordotomy, should be included in the armamentarium available to the neurosurgeon today. To renew appropriate interest in these procedures, evidence and studies that meets today's evidence-based research criteria are warranted.

AB - Object. Historically, destructive procedures for cancer pain were the main line of treatment therapy. However, use of high-dose opioids has essentially replaced such procedures. Recognition of the limits of medical therapy to treat cancer pain effectively is growing, while conversely, in regions with limited access to pain medications, the importance of destructive surgical techniques is increasing. A critical evaluation of the evidence for destructive techniques is warranted, and the authors review current evidence underlying these procedures. Methods. A US National Library of Medicine PubMed search for "ablation," "DREZ," "dorsal root entry zone," "cingulotomy," "cordotomy," "ganglionectomy," "mesencephalotomy," "myelotomy," "neurotomy," "neurectomy," "rhizotomy," "sympathectomy," "thalamotomy," "tractotomy," and "pain" was undertaken. The search was then limited to human studies, English-language literature, cancer pain, and reports with more than 1 patient. Results. One hundred twenty papers were identified and reviewed based on the selection criteria described. According to the Canadian and US task forces, classification of clinical research literature only "sympathectomy" was supported by Class I or II studies, with 2 Class I papers and 1 Class II paper identified for cancer pain. All other procedures were supported by Class III studies of variable quality. Cordotomy in particular was the most extensively studied and reviewed procedure. Given the large number of patients studied, consistent results, multiplicity of reports and, even though evidence quality for individual studies was relatively low, cumulative evidence suggests that cordotomy may play an important role in the treatment of cancer pain. Conclusions. Destructive procedures for cancer pain may play more than a historic role in the management of cancer pain. Cumulative evidence from even the poorest quality studies suggests that some procedures, such as cordotomy, should be included in the armamentarium available to the neurosurgeon today. To renew appropriate interest in these procedures, evidence and studies that meets today's evidence-based research criteria are warranted.

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KW - Myelotomy

KW - Pain

KW - Sympathectomy

KW - Tractotomy

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