Neurosurgical interventions for cancer pain.

Abstract

Half of all cancer patients will develop cancer-related pain, and a fifth of these patients will continue to experience pain refractory to maximal pharmacological therapy. This, together with the opioid crisis, has prompted a resurgence in neurosurgical treatments. Neuromodulatory or neuroablative procedures are largely used for various nonmalignant, chronic pain conditions, but there is growing evidence to support their use in cancer pain. This review aims to cover the main neurosurgical treatments that may prove useful in the changing sphere of cancer pain treatment. Neuromodulation techniques for pain have largely replaced neuroablation in neurosurgical practice due to the higher risk of inadvertent permanent neurological deficits from the latter. When compared to neuroablative approaches for severe treatment-refractory cancer pain, neuromodulation is more expensive (largely due to implant cost) and requires more follow-up, with greater engagement needed from the health service, the patient and their carers. Furthermore, neuroablation has a more rapid onset of effect. Neuromodulation techniques for pain have largely replaced neuroablation in neurosurgical practice due to the higher risk of inadvertent permanent neurological deficits from the latter. Whilst this approach is beneficial when treating nonmalignant pain, neuromodulation in patients with pain related to advanced cancer still has a limited role. Neuroablative procedures are less expensive, require less follow-up, and can have a lower burden on health services, patients and their carers.