Neurosurgical Techniques for Chronic Pain in Adult Cancer Survivors

Chronic pain is a prevalent and often undertreated issue for adult cancer survivors, lasting well beyond the completion of curative treatment or during prolonged maintenance therapy. Historically, pain management in this population has followed strategies similar to those used for active cancer pain - primarily systemic opioids - despite the long-term risks of functional decline, endocrine disruption, and misuse during periods of survivorship that may span decades.

This review examines the evolving role of neuromodulatory and functional neurosurgical interventions for chronic pain in adult cancer survivors. It focuses on five core modalities: spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), peripheral nerve stimulation (PNS), intrathecal drug delivery systems (IDDSs), and cortical stimulation. These interventions are placed in context with three survivor groups: those cured of disease, those living with stable disease on chronic therapy, and survivors of hematopoietic cell transplantation. Emerging clinical evidence supports the use of SCS for treatment-related neuropathic and mixed pain syndromes, while DRGS and PNS show promise in addressing focal neuropathic conditions. IDDS offers a means to deliver targeted analgesia in patients suffering from diffuse or opioid-refractory pain, and cortical stimulation is currently being investigated for highly refractory cases. Each modality is examined in relation to common pain syndromes in survivorship, including chemotherapy-induced peripheral neuropathy, post-surgical neuropathy, radiation fibrosis, graft-versus-host disease-related pain, and musculoskeletal or myofascial pain. The review also explores unique survivorship considerations such as immunosuppression, device longevity, healing complications, and disparities in access and coverage.

Neuromodulation and functional neurosurgical techniques represent an emerging approach for managing chronic pain in adult cancer survivors, providing alternatives to systemic pharmacotherapy that may enhance quality of life and functional independence. The clinical application of these interventions should be guided by pain phenotype, underlying pathophysiology, and long-term survivorship needs. Their integration into cancer survivorship care necessitates careful consideration of patient selection, device management over time, procedural risks in immunocompromised individuals, and the ethical imperative for informed, shared decision-making.