Stereotactic radiosurgery for the treatment of chronic intractable pain: A systematic review

Dustin G. Roberts, Nader Pouratian

Research output: Contribution to journalReview articlepeer-review

Abstract

BACKGROUND: Since the advent of neuromodulation, the role and efficacy of stereotactic radiosurgery (SRS) for chronic pain has not been carefully scrutinized.OBJECTIVE: To perform a systematic review to evaluate the clinical efficacy, both short- and long-term, of SRS for the treatment of chronic intractable pain.METHODS: A systematic search in PubMed, Web of Science, and PsycINFO was performed using keywords and controlled vocabulary. The search included peer-reviewed articles reporting clinical outcomes of SRS for chronic pain with a minimum 3-mo follow-up for nonmalignant and 1 mo for malignant pain.RESULTS: Six articles (113 patients) were evaluated on the basis of radiation target (thalamus vs pituitary) and pain etiology (malignant vs nonmalignant). Across studies, at least 35% of patients were reported to have lasting significant pain relief. By cohort, clinical success was achieved in 51% of pituitary SRS, at least 23% of thalamic SRS, 39% of nonmalignant, and at least 33% of malignant pain patients. Adverse events were noted in 21% of patients; the majority related to hormonal deficits from pituitary SRS.CONCLUSION: Despite decreased utilization, SRS is effective for select patients with chronic pain and is associated with an acceptable complication rate. Pituitary SRS is superior in patients with cancer-related pain (87% success), while thalamic SRS is superior in patients with nonmalignant pain (65% success). Because reports of SRS for pain largely stem from a period before the common use of neuromodulatory and intrathecal therapies, the efficacy in patients who fail such therapies remains unclear and requires further characterization.

Original languageEnglish (US)
Pages (from-to)543-551
Number of pages9
JournalOperative Neurosurgery
Volume13
Issue number5
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Keywords

  • Chronic pain
  • Gamma knife surgery
  • Hypophysectomy
  • Intractable pain
  • Refractory pain
  • Stereotactic radiosurgery
  • Thalamotomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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