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REFRACTORY PAIN: WHEN FUNCTIONAL NEUROSURGERY CAN IMPROVE THE QUALITY OF LIFE

REFRACTORY PAIN: WHEN FUNCTIONAL NEUROSURGERY CAN IMPROVE THE QUALITY OF LIFE. Joseph MAARRAWI, M.D., Ph.D ., H.D.R. Neurosurgeon & Pain S pecialist - Hôtel -Dieu de France - Beirut – LEBANON

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REFRACTORY PAIN: WHEN FUNCTIONAL NEUROSURGERY CAN IMPROVE THE QUALITY OF LIFE

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  1. REFRACTORY PAIN: WHEN FUNCTIONAL NEUROSURGERY CAN IMPROVE THE QUALITY OF LIFE Joseph MAARRAWI, M.D., Ph.D., H.D.R. Neurosurgeon & Pain Specialist - Hôtel-Dieu de France - Beirut– LEBANON Directorof the Laboratoryof Research in Neuroscience – St Joseph University - Beirut – LEBANON La 1ère journée annuelle de lutte contre la douleur 10 Novembre 2018

  2. PATIENT EXPECTATION • “Hôpital sans douleur” Low patient satisfaction • “Ensemble pour luttercontre la douleur” High patient satisfaction

  3. REFRACTORY CHRONIC PAIN Patient withseverechronic pain Neurosurgery for pain Pain relief and patient sastisfaction MULTIDISCIPLINARY APPROACH • COMPLEXITY OF NERVOUS SYSTEM • VERY COMPLEX PAIN MECHANISMS

  4. INTERVENTIONAL AND NEUROSURGICAL TREATMENT –Refractory CONDITIONS Chronic Neuropathic PAINCANCER PAIN FINAL CHOICE

  5. INDICATIONS • Peripheral nerve lesion • Post amputation pain • Failedback surgerysyndrome • Spinal lesion • Complexregional pain syndrom • Brachial plexus avulsion • Cancer pain • Postherpeticpain • Post-stroke pain • Trigeminalneuralgia • Diabeticperipheralneuropathy

  6. NEUROSURGERY FOR PAIN TECHNIQUES

  7. 1- SPINAL CORD STIMULATION – SCS

  8. PERCUTANEOUS TECHNIQUE

  9. SURGICAL IMPLANTATION Open interlaminar approach

  10. STIMULATION PROGRAMMING Patient Médecin

  11. 2- INTRATHECAL PHARMACOTHERAPY

  12. INTRATHECAL PHARMACOTHERAPY • Morphine • Bupivacaine • Clonidine • Baclofen • Ziconotide • …

  13. INTRATHECAL PHARMACOTHERAPY • NEUROPATHIC PAIN • Lower half of the body

  14. PUMP REFILL AND PROGRAMMING

  15. 3- MOTOR CORTEX STIMULATION - MCS

  16. UNDER NEURO-NAVIGATION

  17. 4- Ablative surgery Surgery in the Dorsal RootEntry Zone (DREZ)

  18. Technique of Microsurgical DREZotomy at cervical level(C6, right side)

  19. 5- Ablative surgery RADIOFREQUENCY AND BALLOON

  20. RADIOFREQUENCY TECHNIQUEThermo-lesion

  21. BALLOON TECHNIQUE

  22. GAMMA KNIFE OR RADIOSURGERY

  23. TAKE HOME MESSAGES • Neurosugeryfor chronic pain isindicatedonly if other conservative methods have failed • Multi-disciplinaryapproachismandatory and keypoint for therapeuticsuccess • Hôtel-Dieu de France hospitalcanoffer for patients alltheseneurosurgical techniques for pain relief

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