Management of chronic severe pain: Cerebral neuromodulatory and neuroablative approaches

Research output: Chapter in Book/Report/Conference proceedingChapter

9 Scopus citations


Two approaches are utilized when targeting the brain to treat pain. The first, a non-destructive approach, uses either electrical stimulation of brain targets thought to modulate the process of pain perception, or pharmacological agents are introduced into ventricular spaces to target pain modulating receptors. Electrical stimulation targets include; the thalamic nuclei, the periventricular and periaqueductal grey (PVG and PAG) matter or the motor cortex. Currently, the pharmacological agent of choice for intracerebroventricular injection is morphine. In general, electrical stimulation is used for nonmalignant type pain, and pharmacological modulation for malignant type pain. The second, a destructive approach, is usually employed with the goal of interrupting the signals that lead to pain perception at various levels. Neuroablation is usually performed on cellular complexes such as "nuclei, or gyri" or on tracts with the aim of disrupting the sensory and limbic pathways involved in the emotional processes associated with pain. Specific cerebral neuroablation targets include; the thalamic medial group of nuclei, the cingulated gyrus, and the trigeminal nucleus and tract. There are fewer reports in the literature detailing the brain, when compared to the spine, as a target to treat pain, and further research is required.

Original languageEnglish (US)
Title of host publicationOperative Neuromodulation
Subtitle of host publicationVolume 2: Neural Networks Surgery
PublisherSpringer Wien
Number of pages10
Edition97 PART 2
ISBN (Print)9783211330807
StatePublished - Jan 1 2007

Publication series

NameActa Neurochirurgica, Supplementum
Number97 PART 2
ISSN (Print)0065-1419


  • central pain
  • cerebral chronic pain
  • neuroablation
  • Neuromodulation
  • neuropathic pain
  • neurostimulation
  • review

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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