The relief of intractable pain by surgery.

In general the treatment of any painful condition is the treatment of its cause. But sometimes this is not possible, either because the underlying pathological process cannot be influenced favourably, or because its nature is not known while the pain itself cannot be relieved by medical treatment. Examples of the first subgroup are seen when nerve trunks are involved by malignant disease, by post-radiation fibrosis, or by other forms of scarring, and also the pain of postherpetic neuralgia, of tabes dorsalis and of certain other diseases of the central nervous system. Examples of the second sub-group are seen in tic douloureux and other neuralgias, in causalgia and in painful phantom-limbs. It is in such conditions that, when pain has become severe and disabling, its relief by surgery has to be considered.