Guideline on Neuroablative Procedures for Patients with Cancer Pain

• Management of medically refractory pain in advanced cancer patients remains a significant challenge with the majority of patients experiencing pain, often unrecognized or undertreated
• Neurostimulation procedures are not appropriate for many patients and increasing doses of opioid medication can lead to opioid-induced hyperalgesia
• Neuroablative procedures have made a resurgence in an effort to fill the gaps left by other treatments
• Level II recommendation: Cordotomy should be considered for unilateral somatic pain
• Level III recommendations (categorized by type and location of pain):
  • Unilateral neuropathic or somatic nociceptive pain
    • Rhizotomy
    • Mediodorsal and Basal Thalamotomy
    • Mesencephalotomy (for dermatomes above C5)
  • Craniofacial pain
    • Cranial nerve Rhizotomy
    • Nucleus Caudalis DREZ
    • Trigeminal tractotomy-nucleotomy
  • Midline subdiaphragmatic visceral pain
    • Myelotomy
  • Disseminated pain
    • Cingulotomy
  • Insufficient data exits to make a recommendation regarding DREZ for unilateral body pain

Source

Source:

NEUROSURGERY