Can neurosurgeons treat chronic pain?

Neurosurgery treats pain very well when the pain is caused by an identifiable structural problem: a disc pressing on a nerve root, a tumour compressing the spinal cord, trigeminal neuralgia from a blood vessel touching the trigeminal nerve.

For these, the operation directly addresses the cause — remove the disc, decompress the nerve, move the vessel off the nerve — and the pain usually improves quickly and dramatically.

Neurosurgery is much less useful for generalised chronic pain — widespread back pain without nerve compression, fibromyalgia, or pain that persists years after a previous operation with no new structural cause on imaging. For these, a multidisciplinary pain clinic offers better long-term results than more surgery.

A small subset of severe, otherwise untreatable pain can be helped with neuromodulation — spinal cord stimulators or intrathecal pumps. These are specialised procedures done in select centres, and I will refer you if that is the right path.

If you are living with chronic pain and are not sure where to start, ask your GP for a referral to either a pain specialist or a neurosurgeon. We will help sort out which category you fall into.