PAIN MANAGEMENT: NEUROSURGERY

Neurosurgery has a definite but limited place in the treatment of non-malignant pain. The cutting of nerve pathways or the insertion of spinal cord stimulators are the province of this most specialised of surgical specialities.

The surgical interruption of nerve pathways in the body surgically should be the last treatment offered chronic pain patients.

The following are typical procedures performed by neurosurgeons attempting to obtain control of chronic or intractable pain.

• Sympathectomy involves the surgical excision of part of the sympathetic nervous system on either side of the vertebral column. A rhizotomy is the surgical division of a nerve root, usually the posterior (back) root of a spinal nerve.

• A percutaneous cordotomy is the severing of nerve tracts in the spinal cord through a small incision in the overlying skin of the spine.

• A thalamotomy is the surgical destruction of part of the thalamus, a collection of grey matter at the base of the cerebrum, the brain itself. (The thalamus is important in the pain story because sensory impulses from the entire body pass through it on the way to the cerebral cortex — the largest and uppermost part of the brain.) cerebral cortex-the largest and uppermost part of the brain.)

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