Various neurosurgical techniques can be used to treat patients with chronic pain conditions that have not responded well to less invasive methods. 

Compared with other ways of managing pain, these procedures are extreme and uncommon, so it is important to look at the most recent data available before performing or recommending any of these procedures to make sure these techniques are not out of date.

Despite varying support and data, sympathectomy has been successfully used to treat patients with chronic pancreatitis and pancreatic carcinoma. It has been used to treat other conditions like peripheral vascular disease and Raynaud’s disease as well.

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Dorsal root entry zone lesioning is typically considered for brachial or lumbosacral plexus avulsions pain. Additionally, it may be effective in treating segmental pain resulting from spinal cord injury, postoperative neuralgia, amputation or phantom limb pain. It can also be used to treat malignant pain or pain related to certain facial syndromes.

Spinal cord procedures such as commissural myelotomy can be used in patients with intractable bilateral pain in the lower half of the body. A myelotomy can be favorable for patients with midline pain that does not respond to spinal opiates. Commissural myelotomy is rarely performed.

Stereotactic techniques have aided intracranial ablative procedures. Many patients who undergo these procedures are unresponsive to other medical therapies and have severe pain due to cancer. Patients with a short life expectancy have the best results. Several complications can occur: weakness in ataxia, Horner’s syndrome, dysarthria and hiccups.

Cingulotomy has been performed by physicians to relieve pain in patients who suffer from intractable pain related to an effective disorder with emotional responses. The target of the pain is cingulate gyrus. Complications include: seizures, hemorrhage, headaches and decreased memory.

The PainExam podcast: Neurosurgical Procedures for Chronic Pain Conditions

DISCLAIMER: Dr. Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This blog and related podcast is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.