• Guideline on Neuroablative Procedures for Patients with Cancer Pain

    • Feb 03, 2021
    • Ellen L. Air, MD, PhD, Detroit, MI 

    • Pain

    • Management of medically refractory pain in advanced cancer patients remains a significant challenge with the majority of patients experiencing pain, often unrecognized or undertreated
    • Neurostimulation procedures are not appropriate for many patients and increasing doses of opioid medication can lead to opioid-induced hyperalgesia
    • Neuroablative procedures have made a resurgence in an effort to fill the gaps left by other treatments
    • Level II recommendation: Cordotomy should be considered for unilateral somatic pain
    • Level III recommendations (categorized by type and location of pain):
      • Unilateral neuropathic or somatic nociceptive pain
        • Rhizotomy
        • Mediodorsal and Basal Thalamotomy
        • Mesencephalotomy (for dermatomes above C5)
      • Craniofacial pain
        • Cranial nerve Rhizotomy
        • Nucleus Caudalis DREZ
        • Trigeminal tractotomy-nucleotomy
      • Midline subdiaphragmatic visceral pain
        • Myelotomy
      • Disseminated pain
        • Cingulotomy
      • Insufficient data exits to make a recommendation regarding DREZ for unilateral body pain

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