Abstract
Intractable pain may require neurosurgical intervention. This review provides a critical
update of neurosurgical techniques available to treat this condition. Neurosurgery
can affect pain's pathways from the receptor up to the “centers” of its reception
and perception, either by destroying or by stimulating them. Early in neurosurgery's
development, and still today, ablative procedures are able to suppress or alleviate
pain. However, in most cases, such ablations have only remained effective for a few
months or, at best, a few years. This is why, from the 1960s on, a better understanding
of the mechanism of pain inspired development of electrical and chemical neuromodulation
procedures at every level of the nociceptive system (peripheral nerve, cord, thalamic,
periventricular/aqueductal gray, and cortical centers). The encouraging outcomes that
resulted are attracting increasing attention and interest among clinicians. The indications
for undertaking an ablative vs a neurostimulative procedure, as well as selection
of the anatomical target, depend largely on whether pain is nociceptive or neuropathic,
given that most of these indications overlap to some extent. In addition, because
the published outcomes are not based on universal criteria, it is difficult for the
attending physician to select the type of procedure most suitable to the pain problem.
This brief review surveys the various neurosurgical procedures together with their
corresponding indications in the hope that the information provided will help practitioners
choose (1) the type of neurosurgical therapy most appropriate to their patients' needs
and (2) the neurosurgical group best equipped to implement that choice.
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Article info
Footnotes
Publication of this article was supported by the Collège International de Recherche Servier (CIRS).
STATEMENT OF CONFLICT OF INTEREST: The author has nothing to disclose.
Identification
Copyright
© 2010 Published by Elsevier Inc.
