Neuroablative Procedures for Patients with Cancer Pain

Publication Date: December 20, 2020

Objective

Objective

This patient summary means to discuss key recommendations from the Congress of Neurological Surgeons for neuroablative (removing or disabling nerves) procedures for patients with cancer pain. This patient summary is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Cancer pain can defy all standard attempts to relieve it and become intolerable.
  • Cancers invade, displace and destroy normal tissues. In the process, pain nerves respond to warn of danger. When no longer useful, pain becomes a disease in itself with no redeeming virtues.
  • Pain signals travel through a maze of nerve pathways both outside and inside the brain before they are finally felt as pain.
  • Pain signals often travel in nerves with motor (movement) and non-painful sensation signals, complicating efforts to relieve pain without causing numbness or paralysis (inability to move a part of your body).
  • This patient summary focuses on surgical treatment of cancer pain that has not responded to conventional treatment.

Diagnosis

Diagnosis

  • The source of pain signals and their pathways must be exactly identified.

Treatment

Treatment

  • Each of these surgical procedures interrupts pain signals (and sometimes other nerve signals) at a different place in their pathway. [“-tomy” means “cut” and the rest of each word identifies the anatomy to be cut.]
    • dorsal root entry zone (DREZ) lesioning
    • rhizotomy
    • tractotomy
    • myelotomy
    • cordotomy
    • thalamotomy
    • mesencephalotomy
    • cingulotomy
  • These procedures can be performed with one or more of these techniques:
    • percutaneous radio frequency probes (“lesioning” that uses heat to destroy a nerve)
    • chemical or drug injections
    • open surgery
  • The choice of procedure depends on the anatomy targeted.

Abbreviations

  • DREZ: Dorsal Root Entry Zone

Source Citation

Raslan AM, Ben-Haim S, Falowski SM, Machado AG, Miller J, Pilitsis JG, Rosenberg WS, Rosenow JM, Sweet J, Viswanathan A, Winfree CJ, Schwalb JM. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain. Neurosurgery. 2021 Feb 16;88(3):437-442. doi: 10.1093/neuros/nyaa527. PMID: 33355345; PMCID: PMC7884142.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.