Peripheral Nerve Surgery for Pain

There are two approaches to surgery on the peripheral nervous system for pain control: destructive procedures and implants for neuromodulation. This chapter addresses ablative procedures to the peripheral nerves, the sympathetic chain, and dorsal and ventral spinal roots. In general, these procedures are effective more often than not, at least in the acute period. There is a significant chance of pain recurrence, and deafferentation pains may result in the long term. There is limited evidence supporting these procedures, but the presence of factors such as discrete nerve syndrome may be helpful in clinical decision making. The duration, character, and etiology of pain are also important indicators of surgical approach. Well-designed studies on the efficacy of these interventions are necessary. For now, destructive surgery on the peripheral nervous system is most often considered at the end of treatment algorithms for chronic pain, as an adjunct to programs for functional restoration.