Neurosurgical treatment of intractable pain

Chronic, medically intractable pain exists as one of the most vexing problems facing health care providers. The mainstays of chronic pain therapy include narcotic and nonnarcotic analgesics, physical therapy, anesthetic injection therapies, and psychological therapies. When such routine aggressive therapy has failed, and when patients have undergone multidisciplinary pain clinic evaluation, neurosurgical procedures may be indicated for the control of intractable pain. With advancing knowledge in the neurosciences and increased understanding of the anatomy and physiology of pain transmission and modulation, the neurosurgeon is in a unique position to provide a wide range of treatment options for patients with chronic intractable pain. This article presents a concise review of the current status of neurosurgical procedures used in the management of intractable pain, including ablative and augmentative procedures. For each procedure, the scientific rationale, indications, surgical technique, risks and complications, outcomes, and controversies are presented. By using a critical, scientific approach to these procedures, neurosurgeons can best be prepared to assist in the care of patients suffering from intractable pain.