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

The most common, effective implanted pain control systems include:

• Intrathecal drug delivery. An intrathecal pain pump is a small tube inserted in the spinal canal where the pain signals go to the brain. This tube is connected to a small reservoir of medicine inserted under the skin of your belly. The medicine is regularly delivered to the area of pain through the tube.
• Spinal cord stimulation. Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. An electrical generator is put under the skin. This generator sends electrical pulses to a certain area of the spinal cord through electrodes placed in the spinal cord by a specialist.
• Radiofrequency ablation (also called radiofrequency lesioning) is a 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 doctor find the nerves that are causing your pain. Then the doctor places an instrument under your skin through which electrical stimulation heats the surrounding tissue. The heat "stuns" your nerves, blocking them from sending pain signals to your brain.
• Chemical sympathectomy. Sympathectomy prevents the flow of pain signals. In chemical sympathectomy, the malfunctioning nerve or nerves are destroyed with chemicals, usually stopping or reducing the pain. This procedure, though, 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.
• Decompression is another type of surgery used for nerve pain, such as from trigeminal neuralgia. The doctor cuts open your skin and then tries to move away blood vessels or other body structures that are pressing on nerves and causing 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 term and can lead to other problems that can complicate chronic pain or sometimes make it worse.