Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Acknowledgements
- Foreword
- General abbreviations
- Basic science abbreviations
- PART 1 BASIC SCIENCE
- PART 2 PAIN ASSESSMENT
- Section 2a Pain measurement
- Section 2b Diagnostic strategies
- PART 3 PAIN IN THE CLINICAL SETTING
- Section 3a Clinical presentations
- Section 3b Pain syndromes
- PART 4 THE ROLE OF EVIDENCE IN PAIN MANAGEMENT
- PART 5 TREATMENT OF PAIN
- Section 5a General Principles
- Section 5b Physical treatments
- 34 Physiotherapy management of pain
- 35 Regional nerve blocks
- 36 Principles of transcutaneous electrical nerve stimulation
- 37 Acupuncture
- 38 Neurosurgery for the relief of chronic pain
- Section 5c Pharmacology
- Section 5d Psychosocial
- PART 6 SUMMARIES
- Glossary
- Index
38 - Neurosurgery for the relief of chronic pain
from Section 5b - Physical treatments
Published online by Cambridge University Press: 10 December 2009
- Frontmatter
- Contents
- Contributors
- Preface
- Acknowledgements
- Foreword
- General abbreviations
- Basic science abbreviations
- PART 1 BASIC SCIENCE
- PART 2 PAIN ASSESSMENT
- Section 2a Pain measurement
- Section 2b Diagnostic strategies
- PART 3 PAIN IN THE CLINICAL SETTING
- Section 3a Clinical presentations
- Section 3b Pain syndromes
- PART 4 THE ROLE OF EVIDENCE IN PAIN MANAGEMENT
- PART 5 TREATMENT OF PAIN
- Section 5a General Principles
- Section 5b Physical treatments
- 34 Physiotherapy management of pain
- 35 Regional nerve blocks
- 36 Principles of transcutaneous electrical nerve stimulation
- 37 Acupuncture
- 38 Neurosurgery for the relief of chronic pain
- Section 5c Pharmacology
- Section 5d Psychosocial
- PART 6 SUMMARIES
- Glossary
- Index
Summary
Introduction
It is tempting to think of neurosurgery for the treatment of chronic pain as being a matter of the dramatic interruption or interference with some established ‘pain pathway’. In fact, it has a great deal more to offer, both by conventional treatment of the cause of the pain (e.g. trigeminal neuralgia (TGN)) and in the area of palliative manoeuvres in malignant situations. When surgery is appropriate it can provide satisfactory relief of pain without reducing the quality of life that may result from long-term medication use.
When considering surgery for the treatment of chronic pain, the most important criteria turn out to be the quality of life and its expected duration, resulting from the disease process causing the pain. Pain due to uncontrolled malignancy, with reduced physical capacity and life expectation, will demand prompt treatment, with perhaps greater acceptance of surgical risk than, will that of a sufferer from a protracted but non-life-threatening condition. Patients of advanced age might also, on the same logic, demand expedient surgery, acknowledging the risk.
Palliative neurosurgery for the pain of malignancy
Spinal malignancy
There is no questioning the appropriateness of treating surgically a malignancy of a long bone that has caused a pathological fracture.
- Type
- Chapter
- Information
- Core Topics in Pain , pp. 255 - 260Publisher: Cambridge University PressPrint publication year: 2005