The treatment of chronic pain requires the multidisciplinary involvement of pain medicine, neurology, neurosurgery, orthopedics, as well as psychologists and physical therapists. In the treatment of chronic pain, the cause of the pain should be clarified. If the pain is caused by tumors, tissue or organ anatomical changes (e.g., herniated discs, etc.), the primary cause and the compression of nerves by the anatomical changes should be treated first, and then the treatment should be directed at the pain symptoms. For those whose conservative treatments such as medication, nerve block, physical therapy, psychotherapy, acupuncture, etc. are ineffective or have intolerable side effects, neurosurgical treatment can be used, which mainly includes three methods: neurovascular decompression, neuromodulation and nerve destruction. The selection of indications and surgical operation of neurovascular decompression have been standardized. Neurodestruction is the surgical or radiofrequency destruction of different parts of the pain conduction pathway. Neuromodulation, on the other hand, is an emerging technique in the last 20 to 30 years, including nerve electrical stimulation and intrathecal analgesic infusion. With improved understanding of the pathogenesis of pain and advances in modern technology, nerve electrical stimulation has replaced most nerve disruptions as the treatment of choice for intractable chronic pain internationally. Spinal cord electrical stimulation for peripheral nerve injury Neuroelectrical stimulation is used to relieve pain by targeting different nerve sites that conduct pain with electrical stimulation to reduce pain transmission and reception. Depending on the site of stimulation, it can be divided into motor cortex electrical stimulation, deep brain electrical stimulation, spinal cord electrical stimulation, peripheral nerve electrical stimulation and peripheral nerve regional electrical stimulation. Spinal cord electrical stimulation (SCS) is the most widely used in the field of electrical nerve stimulation and is mainly used to treat two major types of chronic pain: neuropathic pain and pain caused by ischemic diseases. Neuropathic pain includes: peripheral nerve injury pain, low back surgery syndrome, chronic postherpetic neuralgia, complex local pain syndrome, etc.; ischemic diseases include: intractable angina pectoris, peripheral arterial obstructive disease, Raynaud’s disease, etc. Neuralgia caused by peripheral nerve injury is an important indication for SCS, with the most satisfactory analgesic effect and the longest duration of efficacy. These pains can be spontaneous or stimulus-induced, often secondary to trauma, surgery, nerve compression, inflammation, and metabolic disorders (polyneuropathy). The results of a large sample of studies show that, with proper indications, SCS can provide approximately 50% or more pain relief in patients with neuropathic pain, and 60% to 70% of patients can significantly reduce the dosage of other analgesic drugs and improve quality of life and body function. In the United States, post-operative low back pain (FBS) is another major indication for SCS, accounting for more than half of all SCS procedures. A comprehensive survey showed that SCS treatment of FBS can provide more than 50% pain relief. However, the efficacy of SCS for FBS varies relatively widely. Because some patients have mixed pain, SCS is ineffective for the component of pain that remains injurious after surgery, and electrical stimulation needs to be combined with morphine-based medication. In Europe, SCS is mainly used for the treatment of ischemic diseases. Since the early 1970s, treatment of angina pectoris has been the focus of research on SCS, with many reports in the literature each year. research on the economic and social benefits of SCS treatment, the impact on morbidity and mortality, and the mechanism of action has made great progress since 1987, with efficiency rates often reaching 90%, and the number of chest pain episodes, pain levels, and nitroglycerin intake of patients significantly reduced. Exercise tolerance and exercise end time on exercise tests have increased, cardiac function has improved, and quality of life has improved. The treatment of chronic pain requires multidisciplinary involvement of pain medicine, neurology, neurosurgery, orthopedics, and psychologists and physical therapists. In treating chronic pain, the cause of the pain should be clearly identified. If the pain is caused by a tumor, tissue or organ anatomical changes (e.g., herniated disc, etc.), the primary cause and the compression of the nerve by the anatomical changes should be treated first, and then the treatment should be directed at the pain symptoms. For those whose conservative treatments such as medication, nerve block, physical therapy, psychotherapy, acupuncture, etc. are ineffective or have intolerable side effects, neurosurgical treatment can be used, which mainly includes three methods: neurovascular decompression, neuromodulation and nerve destruction. The selection of indications and surgical operation of neurovascular decompression have been standardized. Neurodestruction is the surgical or radiofrequency destruction of different parts of the pain conduction pathway. Neuromodulation, on the other hand, is an emerging technique in the last 20 to 30 years, including nerve electrical stimulation and intrathecal analgesic infusion. With improved understanding of the pathogenesis of pain and advances in modern technology, nerve electrical stimulation has replaced most nerve disruptions as the treatment of choice for intractable chronic pain internationally. Spinal cord electrical stimulation for peripheral nerve injury Neuroelectrical stimulation is used to relieve pain by targeting different nerve sites that conduct pain with electrical stimulation to reduce pain transmission and reception. Depending on the site of stimulation, it can be divided into motor cortex electrical stimulation, deep brain electrical stimulation, spinal cord electrical stimulation, peripheral nerve electrical stimulation and peripheral nerve regional electrical stimulation. Spinal cord electrical stimulation (SCS) is the most widely used in the field of electrical nerve stimulation and is mainly used to treat two major types of chronic pain: neuropathic pain and pain caused by ischemic diseases. Neuropathic pain includes: peripheral nerve injury pain, low back surgery syndrome, chronic postherpetic neuralgia, complex local pain syndrome, etc.; ischemic diseases include: intractable angina pectoris, peripheral arterial obstructive disease, Raynaud’s disease, etc. Neuralgia caused by peripheral nerve injury is an important indication for SCS, with the most satisfactory analgesic effect and the longest duration of efficacy. These pains can be spontaneous or stimulus-induced, often secondary to trauma, surgery, nerve compression, inflammation, and metabolic disorders (polyneuropathy). The results of a large sample of studies show that, with proper indications, SCS can provide approximately 50% or more pain relief in patients with neuropathic pain, and 60% to 70% of patients can significantly reduce the dosage of other analgesic drugs and improve quality of life and body function. In the United States, post-operative low back pain (FBS) is another major indication for SCS, accounting for more than half of all SCS procedures. A comprehensive survey showed that SCS treatment of FBS can provide more than 50% pain relief. However, the efficacy of SCS for FBS varies relatively widely. Because some patients have mixed pain, SCS is ineffective for the component of pain that remains injurious after surgery, and electrical stimulation needs to be combined with morphine-based medication. In Europe, SCS is mainly used for the treatment of ischemic diseases. Since the early 1970s, treatment of angina pectoris has been the focus of research on SCS, with many reports in the literature each year. research on the economic and social benefits of SCS treatment, the impact on morbidity and mortality, and the mechanism of action has made great progress since 1987, with efficiency rates often reaching 90%, and the number of chest pain episodes, pain levels, and nitroglycerin intake of patients significantly reduced. Exercise tolerance and exercise end time on exercise tests have increased, cardiac function has improved, and quality of life has improved. Motor cortical stimulation improves motor function Motor cortical stimulation (MCS) has been used since 1991, mainly for central and peripheral afferent nerve block pain, such as central pain after cerebral hemorrhage or infarction, as well as stump pain and phantom limb pain after amputation, and neuralgia after trigeminal nerve injury. This type of pain is difficult to improve by peripheral electrical stimulation. Electrical stimulation of the motor cortex can inhibit the perception of pain in adjacent areas of the cerebral cortex and, in patients with post-stroke pain, can also improve motor function of the painful limb. For central afferent blocked pain, motor cortex electrical stimulation can be called the ultimate treatment option. Peripheral nerve electrical stimulation for low back pain Peripheral nerve electrical stimulation (PNS) focuses on regional pain innervated by a particular peripheral nerve, such as greater occipital neuralgia and complex localized pain syndromes with well-defined innervation. PNS is a technique developed only in the past 10 years, i.e. electrodes are placed directly under the skin of the painful area by puncture technique, and the analgesic effect is received by electrically stimulating the nerve endings in the painful area, similar to traditional acupuncture and electrotherapy. The technique is relatively simple to perform and can theoretically be applied to intractable pain in various parts of the body where other treatments have failed, but most commonly used for low back pain. In conclusion, the key to successful neurosurgical treatment of chronic pain lies in the recognition of the nature of the patient’s pain, the appropriate choice of treatment method and duration of treatment. The surgical option should be selected based on the patient’s needs and the surgeon’s experience. Neurovascular decompression is preferred for benign pain in the presence of significant nerve compression; neuromodulation is preferred for patients with persistent and sensory present neuropathic pain; and destructive treatment is more appropriate for cancer pain with short survival, neuropathic pain with paroxysmal or evoked components, and patients with predominantly injurious pain. The patient’s survival, quality of life, and pain-related psychological, social, and economic factors should also be fully considered before treatment, and the indications for various neurosurgical treatments should be strictly controlled. Motor cortex electrical stimulation (MCS) was applied in 1991, mainly for central as well as peripheral afferent nerve block pain, such as central pain caused by cerebral hemorrhage or infarction as well as stump pain and phantom limb pain after amputation and neuropathic pain after trigeminal nerve injury. This type of pain is difficult to improve by peripheral electrical stimulation. Electrical stimulation of the motor cortex can inhibit the perception of pain in adjacent areas of the cerebral cortex and, in patients with post-stroke pain, can also improve motor function of the painful limb. For central afferent blocked pain, motor cortex electrical stimulation can be called the ultimate treatment option. Peripheral nerve electrical stimulation for low back pain Peripheral nerve electrical stimulation (PNS) focuses on regional pain innervated by a particular peripheral nerve, such as greater occipital neuralgia and complex localized pain syndromes with well-defined innervation. PNS is a technique developed only in the past 10 years, i.e. electrodes are placed directly under the skin of the painful area by puncture technique, and the analgesic effect is received by electrically stimulating the nerve endings in the painful area, similar to traditional acupuncture and electrotherapy. The technique is relatively simple to perform and can theoretically be applied to intractable pain in various parts of the body where other treatments have failed, but most commonly used for low back pain. In conclusion, the key to successful neurosurgical treatment of chronic pain lies in the recognition of the nature of the patient’s pain, the appropriate choice of treatment method and duration of treatment. The surgical option should be selected based on the patient’s needs and the surgeon’s experience. Neurovascular decompression is preferred for benign pain in the presence of significant nerve compression; neuromodulation is preferred for patients with persistent and sensory present neuropathic pain; and destructive treatment is more appropriate for cancer pain with short survival, neuropathic pain with paroxysmal or evoked components, and patients with predominantly injurious pain. The patient’s survival, quality of life, and pain-related psychological, social, and economic factors should also be fully considered before treatment, and the indications for various neurosurgical treatments should be strictly controlled.