Neurosurgical control of chronic pain

The neurosurgeon can play a significant role in the management of chronic pain. This potential is all to often unrealized or distorted by a lack of knowledge about patients who are suffering from chronic pain. Patient selection is the most important determinant of successful surgical therapy. Patients with chronic pain due to a neoplasm should be offered prompt, definitive neurosurgical intervention. Neurosurgical therapy is less likely to be successful if the pain is secondary to benign disease; tic douloureux is an exception to this rule. If chronic pain behavior is not primarily due to noxious peripheral input, surgery is unlikely to yield any long-term benefit. Augmentation of input by skin stimulation or electrical stimulation of various regions in the peripheral and central nervous system may become important therapeutic procedures for the neurosurgeon.