The important role of pain in neurorehabilitation. The neurosurgeon's approach or (neurorehabilitation: the neurosurgeon's role with special emphasis on pain and spasticity).
Pain syndromes due to peripheral or central nervous system damage, or both, may hinder neurorehabilitation. Control of pain may be obtained by ablative or augmentative procedures. Of the ablative modes only DREZ and Cordectomy are still being employed in cases of pain due to Brachial Plexus Avulsion and conus and cauda damage at T9-L1: in both pain is not simply due to "deafferentiation". The augmentative procedures include spinal cord, deep brain and cortical stimulation. Subarachnoid infusion of drugs (midazolam, clonidine, baclofen, etc.) is a new avenue open to control pain. Indications, results and mechanisms of action of those procedures in neuropathic pain are discussed on the basis of literature and personal experience.
Pagni
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CA
Neurosurgical Clinic, University of Torino, Italy.
Canavero
S
S
Bonicalzi
V
V
Nurisso
C
C
D004599:Electric Stimulation Therapy; D006801:Humans; D009128:Muscle Spasticity / Q000534:rehabilitation / Q000601:surgery; D009422:Nervous System Diseases / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D009493:Neurosurgery / Q000379:methods*; D019635:Neurosurgical Procedures; D010146:Pain / Q000534:rehabilitation*; D010166:Palliative Care; D010819:Physician's Role