Neurosurgical management of cancer pain

Abstract

Although pain is often the most distressing symptom in patients with malignant neoplasms, it is best managed in the context of a total care program. The concept of total care incorporates an effort to eradicate or suppress the underlying malignancy, but, when this is no longer feasible, emphasis is shifted to symptom control to maximize the quality of remaining life. Even though the malignancy cannot be eradicated, an important first step in pain control is the diagnostic identification of the source of pain because it is preferable to treat the pain specifically rather than symptomatically. Advances in various noninvasive methods - pharmacology, radiotherapy, psychotherapy - have become effective in an increasing proportion of patients with advanced cancer, resulting in a decline in the need for neurosurgical intervention. However, in some patients conservative management fails, and neurosurgical intervention should be considered. For those who are candidates for neurosurgical intervention, a wide variety of procedures is available. The selection of specific procedures depends on the source and severity of the pain and on the life expectancy and general condition of the patient.