Surgical management of chronic pain
Techniques
Spinal cord stimulation, lesions – open cordotomy and dorsal root entry zone lesioning.
Indications
- Chronic neuropathic pain; chronic non-malignant pain, including refractory low back pain
- Cancer pain – Treatment for the primary condition, lesions and intrathecal drug delivery systems.
Outcomes are viewed as critically important and over the years the neurosurgical service has several publications to attest to this.
Trigeminal neuralgia and other facial pain
There is a major interest in the management of trigeminal neuralgia, and The Walton Centre has an international reputation for this, evidenced by many publications on the subject.
Trigeminal neuralgia is managed by the neurosurgeons who will deliver microvascular decompression as first-line treatment, medical management and foramen ovale procedures. There is a further interest in other neuralgic pain due to compression syndromes, including hemifacial spasm, tinnitus, otalgia, glossopharyngeal neuralgia.
A joint facial pain clinic is run with neurology, pain medicine for cases of diagnostic difficulty; for trigeminal autonomic cephalgias, including cluster headaches, occipital nerve stimulation is provided, and for some difficult facial neuropathic pains deep brain stimulation may be appropriate. They can also be supported by a facial pain management programme in most challenging to manage facial pain.
Many of these techniques involve implanted devices – these are supported on a day-to-day basis by a team of specialist nurses and physiotherapists working for the neuromodulation service with close support and supervision from the pain and neurosurgical service. There is an intrathecal drug delivery system pump refill clinic, spinal cord stimulator clinics and deep brain stimulation clinics
Contact information
0151 556 3368
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