The role of neurosurgery in the treatment of chronic pain.

Used predominantly in the treatment ofmalignant pain in the trunk, pelvis and lower limbs, the most successful of these — dorsal rhizotomy, spinothalamic cordotomy and myelotomy—were considered todemonstrate, invariably in non-randomised case series, good to excellent results in selected patients with nociceptive cancer pain. Pain relief would usually bemaintained through a survival period of 9e12 months but there were risks of operative mortality, post-lesion dysaesthesia, and impaired motor, sensory and sphincter function.Generally confined to use in cancer patients with a life expectancy of less than 1 year andwith more widespread use of opiates, hospice care and the development of intrathecal drug delivery, these operations became almost redundant.