Dr. Manish K. Singh - How Is Neurosurgery Used To Treat Pain
Manish K. Singh, MD, FAANS, is a well-versed neurosurgeon who diagnoses and treats patients at Southern Brain & Spine in Metairie and New Orleans, Louisiana. Southern Brain & Spine’s mission is to offer patients and referrers timely access to quality, comprehensive, cutting edge neurosurgical care, that encompasses brain... more
How Is Neurosurgery Used To Treat Pain
While surgery shouldn't necessarily be your first line of treatment, Neurosurgery has come a long way as a viable way to treat pain that other forms of treatment were unsuccessful in treating.
Stimulation
It’s been known for a long time that electrical current can block pain pathways. As such, implantable solutions have been developed which are much easier on the body than ablative surgery. In particular, for spine pain, catheter-like electrodes can be inserted to block pain. The patient is kept awake so they can communicate the effectiveness of the implant. There are even procedures to place an electrode by the motor cortex of the brain to inhibit neuropathic pain signals.
Delivery of Intraspinal Medication
Adverse effects from large systemic doses of pain medication can be a problem. One way to avoid this is by delivering very small amounts of pain medication directly to the spinal cord via a subcutaneous pump. The pump can be refilled every few months and lasts around 3 years. This can make a huge difference as 80% of patients feel a decrease in their pain.
Ablative Surgery
While most ablative surgery has been replaced by electrical stimulation or the precise delivery of medication, there are still some ablative surgeries performed. This is usually done with a probe that uses radio frequencies to heat up. This heated element is then placed in specific places to create a lesion that can block pain signals. This can be used to treat complex regional pain syndrome I or II, as well as pain originating around the head and neck.
Selected Pain Syndromes
For cancer patients, there are a variety of surgeries that can be beneficial. Cordotomy is when a needle is inserted into the brain or spine to treat chronic pain. Myelotomy is a surgery of the spine that deals with crossing nerve fibers to help treat intractable pain. Stereotactic Mesencephalotomy, a palliative treatment, serves to sever pain pathways between the source of pain and the brain.
