Neurosurgical control of pain in the patient with cancer

If properly evaluated, the majority of patients with intractable pain caused by visceral as well as somatic malignancy can obtain relief. Analgesics are of great value in some cases. They are especially indicated for patients who have conditions producing pain of short duration or for terminal patients. Radiotherapy may temporarily help most patients with intractable pain. Open or stereotactic surgical intervention and especially interruption of the ascending pain fibers within the spinal cord may give permanent relief to patients who have increasingly severe pain. At present the best results are obtained with percutaneous high cervical electrocoagulation of the spinothalamic tracts. Experience with electrical inhibition of pain based on the gate theory is limited. In the future, however, it may replace the present destructive approaches.