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Tailoring of neurosurgical ablative procedures in the management of refractory cancer pain
  1. Uri Hochberg1,2,
  2. Asaf Berger2,3,
  3. Miri Atias3,
  4. Rotem Tellem2,4 and
  5. Ido Strauss2,5
  1. 1 Institute of Pain Medicine, Division of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  2. 2 Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
  3. 3 Deparment of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  4. 4 The Palliative Care Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  5. 5 Department of Neurosurgery, Neuromodulation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  1. Correspondence to Dr Uri Hochberg, Institute of Pain Medicine, Division of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; urihochberg{at}hotmail.com

Abstract

Introduction Neurosurgical ablative procedures can offer immediate and effective pain relief for patients suffering from refractory cancer pain. However, choosing the appropriate procedure for each patient may not be straightforward and warrants an interdisciplinary approach. The purpose of the current study was to evaluate the outcome of patients with cancer who were carefully selected for neurosurgical intervention by a dedicated interdisciplinary team composed of a palliative physician and nurse practitioner, a pain specialist and a neurosurgeon.

Methods A retrospective review was carried out on all patients who underwent neurosurgical ablative procedures in our institute between March 2015 and September 2019. All patients had advanced metastatic cancer with unfavorable prognosis and suffered from intractable oncological pain. Each treatment plan was devised to address the patients’ specific pain syndromes.

Results A total of 204 patients were examined by our service during the study period. Sixty-four patients with localized pain and nineteen patients with diffuse pain syndromes were selected for neurosurgical interventions, either targeted disconnection of the spinothalamic tract or stereotactic cingulotomy. Substantial pain relief was reported by both groups immediately (cordotomy: Numerical Rating Scale (NRS) 9 ≥1, p=0.001, cingulotomy: NRS 9 ≥2, p=0.001) and maintained along the next 3-month follow-up visits.

Conclusions An interdisciplinary collaboration designated to provide neurosurgical ablative procedures among carefully selected patients could culminate in substantial relief of intractable cancer pain.

Trial registration number IR0354-17.

  • pain management
  • cancer pain
  • treatment outcome
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Footnotes

  • UH and AB contributed equally.

  • Contributors UH and AB equally contributed. UH, IS and RT comanage the interdisciplinary service for refractory cancer pain. MA is the head nurse of the service. IS and AB are the neurosurgeons performed the neurosurgical procedures. All of the above took active role in creating the concept and design of the study. MA was in charge of collecting and recording the data. UH, AB and IS carried the analysis and interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the hospital’s ethics committee (No. 0354–17).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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