Surgical Treatment of Neuropathic Pain

Abstract

Surgical treatment of intractable neuropathic pain has evolved significantly during the past few decades. Early treatments focus on neuroablation of the pain pathways. Although these techniques still have a role in specific indications, they have largely fallen out of favor due to causing irreversible destructive damage to the brain and/or spinal cord. Spinal cord stimulation, peripheral nerve stimulation, and intrathecal drug delivery system using programmable pump have become more popular treatment options for patients who do not respond to pharmaceutical and interventional procedures. These methods have reasonable safety profiles and can be efficacious and cost-effective, especially for patients with failed back surgical syndrome and complex regional pain syndrome. Deep brain stimulation and motor cortex stimulation are options for central pain. Microvascular decompression surgery and Gamma Knife radiosurgery are excellent options in selected patients with refractory trigeminal neuralgia or glossopharyngeal neuralgia.