title: [Neurosurgical treatment of chronic pain].
abstract: Neurosurgical treatment of pain used two kind of techniques: 1) Lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (drezotomy, cordotomy, tractotomy…). They are indicated to treat morphine-resistant cancer pain and few cases of selected neuropathic pain. 2) Neuromodulation techniques try to decrease pain by reinforcing inhibitory and/or to limit activatory mechanisms. Chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation…) is used to treat chronic neuropathic pain. Intrathecal infusion of analgesics (morphine, ziconotide…), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, selected patients with severe and chronic pain, refractory to all other treatments. The quality of the analgesic outcome depends on the relevance of the indications.
authors: Service de neurochirurgie, CHU de Nice, 06000 Nice, France. Electronic address: fontaine.d@chu-nice.fr.
authors: D
authors: D
authors: Fontaine
authors: Service de neurochirurgie, CHU de Lille, 59037 Lille, France.
authors: S
authors: S
authors: Blond
authors: Service de neurochirurgie, Hospices Civil de Lyon, 69003 Lyon, France.
authors: P
authors: P
authors: Mertens
authors: Département d'évaluation et de traitement de la douleur, CHU de Nice, 06000 Nice, France.
authors: M
authors: M
authors: Lanteri-Minet
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy / Q000601:surgery*; D004351:Drug Resistance; D004599:Electric Stimulation Therapy; D006801:Humans; D015918:Infusion Pumps, Implantable; D009434:Neural Pathways / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D010148:Intractable Pain / Q000601:surgery
chemical_list: D000700:Analgesics
keywords: Chirurgie; Chronic pain; Douleur chronique; Drezotomie; Drezotomy; Intrathecal therapy; Motor cortex stimulation; Neuromodulation; Spinal cord stimulation; Stimulation corticale; Stimulation médullaire; Surgery; Thérapie intrathécale