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17. Cancer Pain: Part I: Cordotomy for Unilateral Pain due to Cancer
Bregje Huisman1,2, Martine Puylaert3, Liong Liem1
1Department of Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Summary
Percutaneous cordotomy offers significant pain relief for unilateral cancer pain unresponsive to other treatments. This review of recent studies shows high efficacy and low complication rates for this procedure.
Area of Science:
- Neurosurgery
- Pain Management
- Oncology
Background:
- Oncological pain affects a significant portion of cancer patients (44.5%), with many experiencing moderate-to-severe pain (30.6%).
- Pharmacological and intrathecal treatments have limitations in managing refractory cancer pain.
Purpose of the Study:
- To summarize recent literature (2016-2024) on percutaneous cordotomy techniques.
- To evaluate clinical outcomes of percutaneous cordotomy for unilateral cancer pain.
Main Methods:
- A scoping review of Medline and Embase databases was conducted.
- Literature search covered studies from inception to September 9, 2024.
- Included 18 studies (18 retrospective, 18 prospective) involving 596 patients.
Main Results:
- Percutaneous cordotomy is indicated for unilateral pain below C4 unresponsive to conservative measures.
- Excellent immediate pain relief (86%-98%) and sustained relief at 6 months were reported.
- Low rates of permanent complications (e.g., paresis) were observed, though mirror pain incidence varied.
Conclusions:
- Multidisciplinary management is crucial for cancer pain.
- Percutaneous cordotomy is a viable option for refractory unilateral cancer pain when conservative treatments fail.
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