17. Cancer Pain: Part I: Cordotomy for Unilateral Pain due to Cancer

Despite advancements in pharmacological and intrathecal treatment of oncological pain, it remains a significant challenge, affecting 44.5% of patients with cancer, with 30.6% experiencing moderate-to-severe pain.

This scoping review provides a summary of the literature from 2016 to 2024, focusing on percutaneous cordotomy techniques and clinical outcomes for the treatment of unilateral pain in patients with cancer. A literature search (in Medline and Embase) was performed from inception up to September 9, 2024, in collaboration with a medical information specialist.

A comprehensive multidimensional assessment is essential when considering cordotomy. Ideal candidates have unilateral pain unresponsive to more conservative measures, localized below the C4 level. A detailed neurological examination is crucial for intra-procedural assessment and to evaluate potential post-procedural muscle weakness and sensory deficits. Our search identified 18 studies, half of which were retrospective and half prospective, including 596 patients in total. Studies varied regarding imaging technique and included fluoroscopy, CT-guided, or via microendoscopy. Excellent immediate pain relief was reported in between 86% and 98% of patients. Of patients surviving 6 months, the majority still experienced sustained pain relief. There is no consensus regarding optimal lesion temperature and duration. The reported rate of permanent complications such as paresis is low. The reported incidence of mirror pain is highly variable.

Cancer pain should ideally be managed in a multidisciplinary and multimodal manner. When conservative treatment fails, a percutaneous cordotomy can be considered for refractory unilateral pain.