Neurosurgical treatment of cancer pain.

Neurosurgical pain operations in carcinoma patients should always be considered when conservative treatment methods fail or pain relief can be attained only at the cost of undesired side effects. The therapeutic spectrum of neurosurgery has been appreciably extended in recent years. Due to the introduction of percutaneous surgery methods, the operations have become less burdensome, so that carcinoma patients who were formerly regarded as inoperable can also be given neurosurgical pain treatment. The advances in neurophysiology have led to a better understanding of pain mechanisms, in consequence of which the various possibilities of treatment can be employed more specifically with prospects of better treatment results. The spectrum of neurosurgical treatment extends from destructive measures (rhizotomies, cordotomies, thalamotomies, neurolytics) via intrathecal administration of morphine-like substances to the augmentative nondestructive neurostimulation techniques. Despite the advances in conservative therapy of cancer pain, in many cases, a neurosurgical procedure is most efficacious in controlling carcinoma pain.