Neurosurgical Invasive Techniques for Cancer Pain: A Pain Specialist's View

Neurosurgical techniques for management of cancer pain can be divided into two categories: reconstructive and ablative. For patients with pain from spinal metastatic disease, the newer surgical methods of anterior decompression and stabilization provide reliable pain control while preventing serious neurologic progression. Minimally invasive techniques for vertebral stabilization, such as vertebroplasty, may also effectively relieve pain from spinal metastases associated with low morbidity. Traditionally, stereotactic and functional neurosurgical techniques have been used to produce selective lesions in neuroanatomic pathways that mediate pain. Improvements in pharmacologic therapy, including treatment with intraspinal opioids, have led to a marked reduction in the use of ablative stereotactic methods. Nevertheless, cordotomy and certain other selectively destructive procedures still have a role in the management of patients with unremitting cancer pain. Technological developments in methods of lesion production could lead to the increased use of these methods.