Neurosurgical management of chronic pain

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By Richard S Polin MD

Chronic pain encompasses a spectrum of clinical scenarios involving both peripheral and central pain syndromes. In this clinical summary, Richard S Polin MD discusses the progression of understanding about the pathophysiology of pain, culminating in the gait theory hypothesis. The author addresses pain from peripheral nerve injury, spinal cord injury, and brain injury and stroke and discusses the basic science behind the rationale for current management schemes and pain treatments (both pharmacological and surgical). In this update, the author includes a section on evidence-based reviews of central treatments for chronic cancer and brachial plexus pain. The author concludes by summarizing the success (or lack thereof) of surgical treatment modalities for chronic pain.

Key Points

  • Both physical and psychological aspects of chronic pain are significant and should be considered.
  • Treatment of chronic pain is multidisciplinary with simultaneous pharmacological, behavioral, exercise, and procedural treatments often needed in concert.
  • Surgical strategies have been devised to downregulate pain receptors peripherally and pain pathways centrally.

In This Article

Historical note and nomenclature
Clinical applications
References cited