Colloquium--is there a surgical cure for pain?

We have heard today that psychological factors are extremely important in pain problems and that careful psychiatric assessment should delineate patients who have the potential of achieving good pain relief with interventional procedures. The bulwarks of the neurosurgical management of pain have been peripheral neurectomy, rhizotomy, sympathectomy, and cordotomy. We have heard each of these discussed. Peripheral neurectomy and rhizotomies are not highly successful in the treatment of pain, but are useful in carefully chosen patients. Cordotomy remains an excellent technique for the management of many patients with chronic pain or malignancy, and sympathectomy can be one of the most gratifying operations performed, as long as the patients are well chosen. The major lesson we have learned today is that there is no cure for pain at the present time. Nevertheless, neurosurgical procedures remain an important part of pain management. They should be applied after an adequate diagnosis is made, after psychiatric characterization of the entire pain problem is complete, and only when there is only a definitive pain generator which can be relieved by an interventional procedure. Perhaps the most important message we have heard is the categorization of pain patients given us by Doctor Hendler. It is important that we all identify those patients with affective or exaggerated pain behavior so that interventional procedures are carried out only on those patients who have a real possibility of benefiting from them. I believe if we all do this, we will see a significant increase in the effectiveness of surgical procedures for pain.