In developed countries, it is estimated that patients with various types of chronic pain account for 30% of the entire population. In China, there are more than 100 million pain patients, about 30% of adults suffer from chronic pain, and two out of every three outpatients are patients with various pain disorders and symptoms. In other words, about 30% of the total population of the earth is suffering or has experienced one kind of chronic pain, which is a very large group of people and needs professional institutions, specialist doctors and specialized disciplines to study and treat. According to the spirit of the document, pain departments are established in hospitals above the second level, which are specialized in the diagnosis and treatment of chronic pain.
Chronic pain is divided into receptor-derived pain and neurogenic pain. The former arises from direct stimulation of nociceptive receptors and conduction to higher nociceptive centers via nerve axons, and is sensitive to nerve disruption and analgesics, such as most cancer pain and migraine.
In contrast, neurogenic pain arises from the nuclei and conduction tracts of nociceptive perception and is insensitive to conventional conservative treatment of chronic pain based on oral analgesics and local nerve blocks, and can only be addressed by neurosurgery.
Modern neurosurgical pain relief procedures characterized by minimally invasive and microscopic operations have the following characteristics.
1. obvious pain relief and less likely to recur; 2. safe and less invasive surgery; 3. low incidence of complications and sequelae.
The following are the common neurosurgical procedures and typical indications according to neurological positioning.
Brain
1, stereotactic brain nucleus destruction (neuropathic pain after brain injury represented by post-stroke pain and post-traumatic brain injury pain)
2.Electrical stimulation of the cerebral cortex or nucleus accumbens (as above)
3, analgesic pump intracerebroventricular perfusion (intractable diffuse cancer pain)
Spinal cord
1, dorsal root disruption into the medullary region (spinal cord injury after neuropathic pain represented by nerve root avulsion injury pain and postoperative pain of cervical and lumbar spondylosis)
2, spinal cord electrical stimulation (as above)
3, analgesic pump intrathecal perfusion (intractable diffuse cancer pain)
Nerve root
1.Microvascular decompression (trigeminal neuralgia, glossopharyngeal vagal neuralgia)
2.Dorsal root ganglioneurotomy; (recalcitrant confined cancer pain)
3, sympathectomy of sympathetic nerve chain (complex localized pain syndrome)
Peripheral nerve
1. neuroma resection.
2.Neurovascular decompression or dissection (neurogenic migraine)
3.peripheral nerve electrical stimulation (intractable peripheral neuralgia)
Extra neurological pain surgery makes up for the lack of traditional chronic pain treatment and is the ultimate means of pain treatment.