Surgery to treat pain (rather than the underlying disease) is only appropriate
in cases where more conservative approaches have failed and where trained
neurosurgeons and follow-up care are available.
A surgeon can cut a nerve close to the spinal cord (rhizotomy) or bundles
of nerves in the spinal cord (cordotomy) to interrupt the pathways that
send pain signals to the brain.
For example, a patient who has a painful neuroma develop after a nerve
injury might be cured if the neuroma is removed. Patients with so-called
sympathetically-maintained pain are sometimes offered surgery
that cuts sympathetic nerves. Patients with cancer or other serious diseases
are occasionally offered a surgical technique in which a cut is made in
nerves or the spinal cord to try to block activity in the nervous system
that may be sustaining the pain. All of these surgical approaches have
some risks, and the availability of new therapies, such as neuraxial infusion
and spinal cord stimulation, has steadily decreased their use.
In the best possible outcome, surgery relieves pain and the need for most
or all pain medication. However, surgery carries the risk of:
Stopping the pain only briefly
Creating new pain from nerve damage at the site of the operation
Limiting the patient's ability to feel pressure and temperature
in the region, putting him or her at risk for injury
