Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer

Shepherd, Timothy M.; Hoch, M.; Cohen, B.A.; Bruno, Mary; Fieremans, Els; Rosen, Galia; Pacione, Donato; Mogilner, Alon Y.

doi:10.3174/ajnr.a4981

Cited by 18 publications

(3 citation statements)

References 19 publications

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“…Primarily, this means extensive systemic narcotic regimens and neuromodulation via intrathecal opioids. Traditional neurosurgical procedures such as percutaneous cordotomy or myelotomy only address the sensorydiscriminative aspect of pain by lesioning the pathways from which pain is transmitted from the periphery to the brain (5,7,8,(18)(19)(20)(21). While this may be effective for certain types of pain.…”

Section: Discussionmentioning

confidence: 99%

Case report: MR-guided laser induced thermal therapy for palliative cingulotomy

Allam

Larkin²,

Katlowitz³

et al. 2022

Front. Pain Res.

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In end-stage cancer, oncologic pain refractory to medical management significantly reduces patients' quality of life. In recent years, ablative surgery has seen a resurgence in treating diffuse and focal cancer pain in terminal patients. The anterior cingulate gyrus has been a key focus as it plays a role in the cognitive and emotional processing of pain. While radiofrequency ablation of the dorsal anterior cingulate is well described for treating cancer pain, MRI-guided laser-induced thermal therapy (LITT) is novel. Our paper describes a patient treated with an MRI-guided LITT therapy of the anterior cingulate gyrus for intractable debilitating pain secondary to terminal metastatic cancer.

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Section: Discussionmentioning

confidence: 99%

Case report: MR-guided laser induced thermal therapy for palliative cingulotomy

Allam

Larkin²,

Katlowitz³

et al. 2022

Front. Pain Res.

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“…Internationally, this decline is also recognised with cordotomy being considered a ‘dying art’ within North America and the practice of PCC being infrequently used 15. Within the last decade, only three medical centres within the USA have reported on their PCC performance 16. Globally, unless PCC is highlighted as an essential procedure for the management of complex pain, and specific teaching provided within specialist training programmes, expertise will disappear.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous cervical cordotomy for cancer-related pain: national data

Poolman

Makin

Briggs

et al. 2020

BMJ Support Palliat Care

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ObjectivesPercutaneous cervical cordotomy (PCC) is an interventional ablative procedure in the armamentarium for cancer pain treatment, but there is limited evidence to support its use. This study aimed to assess the effectiveness and safety of PCC.MethodsAnalysis was undertaken of the first national (UK) prospective data repository of adult patients with cancer undergoing PCC for pain treatment. The relationship between pain and other outcomes before and after PCC was examined using appropriate statistical methods.ResultsData on 159 patients’ PCCs (performed from 1 January 2012 to 6 June 2017 in three centres) were assessed: median (IQR) age was 66 (58–71) years, 47 (30%) were female. Mesothelioma was the most common primary malignancy (57%). The median (IQR) time from cancer diagnosis to PCC assessment was 13.3 (6.2–23.2) months; PCC to follow-up was 9 (8–25) days; and survival after PCC was 1.3 (0.6–2.8) months. The mean (SD) for ‘average pain’ using a numerical rating scale was 6 (2) before PCC and 2 (2) at follow-up, and for ‘worst pain’ 9 (1) and 3 (3), respectively. The median (IQR) reduction in strong opioid dose at follow-up was 50% (34–50). With the exception of ‘activity’, all health-related quality of life scores (5-level version of EuroQol-5 Dimension) either improved or were stable after PCC. Six patients (4%) had PCC-related adverse events.ConclusionsPCC is an effective treatment for cancer pain; however, findings in this study suggest PCC referrals tended to be late in patients’ disease trajectories. Further study into earlier treatment and seeking international consensus on PCC outcomes will further enhance opportunities to improve patient care.

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“…Percutaneous cordotomy with computed tomography (CT) guidance is safer than the open cordotomy of the 1950s. 10,11,12,13,14 Magnetic resonance imaging (MRI) guidance, together with intraoperative neurophysiological testing, increases accuracy of deep-brain stimulation targeting to a fraction of a millimeter. 15 Advancement from a single-contact electrode to 32-contact electrodes provides countless options for stimulation paradigms in cases of spinal cord stimulation.…”

Section: Introductionmentioning

confidence: 99%

Revisiting the WHO Analgesic Ladder for Surgical Management of Pain

McGuire

Slavin

2020

AMA Journal of Ethics

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The opioid epidemic challenges current attitudes toward pain management and necessitates the reexamination of the World Health Organization (WHO) 3-step analgesic ladder, introduced in 1986 for cancer pain management. Surgical treatment of pain is a logical extension of the original guideline, which is often absent in conversations with patients about treatment options for their pain and consequentially underutilized. However, with concerns growing regarding opioid use, a shift in the stepwise approach of the WHO analgesic ladder in an age of developing technology and surgical offerings could have profound implications for patients and public health. Surgical interventions potentially provide a long-term, cost-effective management strategy to reduce opioid use. This review canvasses surgical options, highlights literature on failed back surgery syndrome and spinal cord stimulation and reconsiders the current ladder approach to pain management. To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM .

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Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer

Cited by 18 publications

References 19 publications

Case report: MR-guided laser induced thermal therapy for palliative cingulotomy

Case report: MR-guided laser induced thermal therapy for palliative cingulotomy

Percutaneous cervical cordotomy for cancer-related pain: national data

Revisiting the WHO Analgesic Ladder for Surgical Management of Pain

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