Surgical approaches to chronic pain

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© Springer International Publishing AG 2018. The surgical treatment of chronic pain has evolved significantly over the last 50 years. Early treatments for intractable pain focused on selective lesioning of the pain pathways especially the spinothalamic tract. While these techniques have fallen out of favor, they are still used in some cases to manage cancer pain. The discovery that electrical stimulation or intraspinal drug infusions can predictably and safely control pain revolutionized the treatment of patients who had few pharmacological options. Spinal cord stimulation is an effective way to augment other pain therapies especially for patients with failed back surgery syndrome and complex regional pain syndrome. Deep brain stimulation and motor cortex stimulation are other options of last resort for refractory pain. Continuous infusion of intrathecal medication via a programmable pump is another option in patients who do not respond to standard therapy. In patients who do not tolerate the side effects or who do not respond to medications for trigeminal neuralgia, microvascular decompression and percutaneous and stereotactic radiosurgery are options.

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Fundamentals of Pain Medicine



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