Pain is like a lingering ghost that accompanies human life, and sometimes it is even more frightening than death, especially chronic pain, which can be unbearable. The 10th World Congress of Pain Organizations (August 2002) listed chronic pain as an “independent disease”. The prevalence of chronic pain in adults is 40%, while the prevalence in the elderly is as high as 65% to 80%. With the gradual arrival of the aging society, there will be more and more patients with chronic pain. The persistence of pain will delay the recovery of patients, increase the burden of patients and their families, increase medical costs, cause the loss of work, family, and dignity, cause depression, anxiety, suicide, and disability in an expanding group, and reduce the quality of life of patients and their families. Therefore, how to solve the problem of pain is becoming a subject of increasing concern in the medical community. Neurosurgical treatment of intractable pain has undergone great changes in the past two to three decades, and neurodestructive surgery, although still occupying a very important clinical place, is gradually being replaced by neurostimulation (or modulation) treatments including spinal cord and peripheral nerve stimulation, deep brain electrical stimulation, and motor cortex stimulation. Moreover, different types of pain require different treatment methods. The following are a few of the more mature neurosurgical treatments and their indications from abroad in recent years: I. Stimulation therapy Stimulation therapy is divided into two categories: electrical stimulation (spinal cord, peripheral nerve, motor cortex and deep brain electrical stimulation) and central drug infusion (intrathecal and intracerebroventricular). The advantages of stimulation are safety, reversibility and “modifiability”, while the biggest disadvantages are the high cost (including stimulators and electrodes) and the need for maintenance (e.g. pump reperfusion, stimulator battery replacement). 1. The main indication for spinal cord stimulation (SCS) is neuropathic pain in one limb, which should be relatively limited and fixed in nature. Common disorders include: persistent radicular pain due to post-surgical back pain syndrome or neuropathic pain associated with complex limited pain syndrome. SCS is also effective for neuropathic pain in the trunk, such as postherpetic pain or certain types of post-open-chest pain. SCS can also be used to treat limb pain due to peripheral neuropathy and nerve root injury, phantom limb pain, limb ischemic pain due to peripheral vascular disease, and even angina pectoris. Peripheral nerve electrical stimulation (PNS) is mainly applied to regional pain confined to a certain peripheral nerve innervation, and other indications are similar to SCS. 2. Intracranial electrical stimulation treatment includes deep brain electrical stimulation (DBS) of the thalamus, paraventricular-parapatellar gray matter (PVG-PAG) and motor cortex electrical stimulation. These methods are mainly used to treat non-cancerous pain, such as post-surgical back pain syndrome, neuropathic pain due to central or peripheral nervous system injury, or trigeminal neuralgia. the target site of DBS should be selected according to the nature of the pain. 3. Motor cortex electrical stimulation is a new and highly regarded treatment alternative to thalamic and PVG-PAG electrical stimulation. It is mainly used for neuropathic pain syndromes and is particularly effective for some intractable facial pain, such as neuropathic pain of the trigeminal nerve. Motor cortex electrical stimulation is more effective than DBS when there is no sensory deficit in the pain distribution area. Because the electrodes are placed in the epidural rather than in the brain, it has fewer complications. 4. Central drug infusion is a very popular treatment for intractable pain. It has a wide range of indications, including injurious pain and mixed pain, and can be used to treat focal or diffuse pain (e.g., pain due to systemic bone metastases), as well as axial or limbic pain. Because injurious pain is more sensitive to opioids, the primary indication for central drug infusion therapy is pain syndromes with significant injurious pain components such as cancer pain. The main indications for intralesional drug infusion therapy are post-surgical back pain syndromes, including lower back injurious pain and limb neuropathic pain components. Second, destructive therapy Despite the increasing prevalence of stimulation therapy, destructive therapy still occupies an important place in the neurosurgical treatment of pain. Destructive treatments include destruction of peripheral nerves (blocking or altering the transmission of injurious stimuli to the center, including neurotomy, ganglionectomy, and radiculotomy), destruction of the spinal cord (altering the afferent pathway or upward transmission of injurious stimuli, including DREZ disruption, anterolateral spinal cord column dissection, and anterior joint spinal cord dissection), and intracranial destruction above the level of the spinal cord (blocking the transmission of injurious stimuli or affecting the perception of painful stimuli). (blocking the transmission of injurious stimuli or affecting the perception of painful stimuli, including destruction of the mid-spinal tract, destruction of the medial thalamus, and destruction of the anterior cingulate gyrus). The efficacy of destructive therapy depends on the selection of the appropriate type of pain for the patient. Destructive therapy is more appropriate for injurious pain rather than neuropathic pain. Lateral anterior column dissection (LST or Cordotomy): This includes CT-guided percutaneous radiofrequency destruction of the anterior lateral column and open anterior lateral column dissection. The aim is to block the thalamic tract of the spinal cord. It is more effective with injury pain such as cancer pain, pain after spinal cord injury and pain after brachial plexus injury. Generally, the anterolateral spinal cord bundle cut at the level of cervical 2 is performed for pain in the upper extremities, upper abdomen and chest; the anterolateral spinal cord bundle cut at the level of thoracic 2 is appropriate for pain in the abdomen, perineum and lower extremities. Disadvantage: loss of sensation in the contralateral limb below the plane of dissection. Anterior joint spinal cord dissection: mainly for pain or visceral pain in bilateral, midline areas of the trunk; anterior joint dissection of the cervical 4 – thoracic 1 vertebral segments can be done for the upper extremities; anterior joint dissection of the thoracic 2 – thoracic 8 vertebral segments of the general spine for thoracic pain and thoracic back pain; anterior joint spinal cord dissection of the thoracic 7 – lumbar 1 vertebral segments is appropriate for abdominal pain, pelvic pain and lower extremity pain. DREZ dissection includes spinal cord DREZ dissection and caudal trigeminal nucleus DREZ dissection Posterior spinal cord root like medullary zone (DREZ) dissection: for precisely localized segmental pain such as: pain after brachial plexus avulsion injury or pain after lumbar plexus avulsion injury; central neuralgia after spinal cord injury or paraplegia; stump pain or phantom limb pain after amputation; neuralgia after herpes zoster. Caudal DREZ dissection of the trigeminal nucleus is very effective for facial nerve afferent pain and less effective for facial pain of peripheral nerve origin (e.g., traumatic trigeminal neuralgia). Minimally invasive intracranial stereotactic disruption for pain management Midbrain Tractomy MBT: For cancer pain, injury pain and central neuropathic pain in the contralateral limb, especially involving the head and face. Most authors report an efficiency rate of more than 85-90% for cancer pain. Medial thalamotomy: Some nuclei of the medial thalamus, central medial nucleus (CM), parabrachial nucleus (PF), central lateral nucleus (CL) and dorsal medial nucleus (DM), are involved in the process of pain production. Some authors have reported an efficiency of 60-70%. Cingulotomy: The anterior cingulate gyrus plays an important role in the modulation of pain afferents and efferents and is indicated for all types of chronic intractable pain, especially in patients with chronic pain associated with mental and emotional changes. It has an efficiency of 70-80%. It is safe and has few side effects. Hypophysectomy: The method of intra-saddle injection of anhydrous alcohol is mainly used, which has many side effects and complications, therefore, it is only used for cancer pain, especially hormone-dependent cancer pain, and is not advocated for benign chronic pain such as thalamic pain. At present, the application of stereotactic radiosurgery (gamma knife) for pituitary disruption has been increasingly reported, and has gradually replaced the method of intra-saddle injection of anhydrous alcohol because of its safety and few side effects. In conclusion, the key to the success of neurosurgical treatment of intractable pain lies in the appropriate selection of patients, treatment methods, and treatment time. While carefully selecting patients suitable for neurosurgical treatment, it should be fully understood that chronic pain is a physical and psychological disease. In patients with persistent neuropathic pain with sensory loss, stimulation therapy is preferable to destructive therapy. In contrast, destructive therapy is more appropriate for patients with cancer pain with a short survival period, neuropathic pain with a paroxysmal or evoked component, and patients with predominantly injurious pain.