Chronic Pain: Surgery

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Surgery

Surgery is not often used to treat chronic pain. The decision to have surgery depends on your condition and the cause of your pain. Surgery is usually considered only after other treatments have failed, or if it is considered medically necessary.

Surgery may provide pain relief, but it also may permanently damage your ability to perceive other sensations, such as light touch and temperature changes. It can also cause a different pain to occur.

Surgery Choices

Surgically implanted pain control devices may be an option if you have severe chronic pain. These devices deliver drugs or a mild electrical current to the spinal cord. However, they are not effective or appropriate for everyone. Your doctor may recommend that you try a temporary device to see if it helps you.

The most common, effective implanted pain control systems include:

• Intrathecal drug delivery, which injects a medicine such as morphine or ziconotide (Prialt) into the spinal fluid through a small, adjustable, implanted pump.
• Spinal cord stimulation, which administers a small electrical current to the spinal cord from an implanted power source. The electrical current is adjusted with a controller.

A technique called chemical or surgical sympathectomy prevents the flow of pain signals. In surgical sympathectomy, the malfunctioning nerve or nerves are cut, usually stopping or reducing the pain. However, this procedure may also destroy other sensations besides pain, or create other sensations such as burning or numbness. This treatment may be used for a type of chronic pain called reflex sympathetic dystrophy, which is a condition that affects the nervous system. This procedure is not commonly done because it can cause side effects that include new pain and sweating. Your doctor may want to try a sympathetic nerve block first, in which local anesthetic is injected into the nerve to relieve pain.

Radiofrequency lesioning (also called radiofrequency ablation) is another procedure that can disrupt the flow of pain signals. First, you will need to have a test that uses a nerve block, which numbs specific nerves, to help your health professional locate the nerves that are causing your pain.

What To Think About

Surgically implanted devices are not commonly used to treat chronic pain. They may not always control chronic pain in the long run and can lead to other problems that can complicate chronic pain or sometimes make it worse.

Last updated:	February 22, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Kathleen Romito, MD - Family Medicine, Nancy Greenwald, MD - Physical Medicine and Rehabilitation
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC