Patients with Cancer Pain Are Deserving Better Care

From its beginnings, at the end of the 19th century, neurosurgery has developed, in line with advances in scientific knowledge about pain pathways and their modulation, numerous analgesic strategies. The description of the nociceptive pathways along the spinal cord and brain has initially enabled the development of techniques for interrupting nociceptive messages at different levels of the central nervous system. Then, the description of gate control correlates with the rapid introduction of electrical stimulation for analgesic purposes. The description of endomorphine receptors in the central nervous system induces the possibility of intrathecal infusion of antalgic molecules. All these approaches have reinforced over time neurosurgeons' ability to fight against intractable pain.In spite of the development of antipain pharmacology, still a significant percentage of pain is drug-resistant. The incidence of cancer as a disease has significantly increased other the last decades. Advances in cancerology have dramatically improved the survival of cancer patients with the paradoxical consequence, with more survivors, to have the physician facing much more patients presenting with intractable pain due to cancer. A systematic review and meta-analysis indicate that the prevalence of cancer pain is 55% during anticancer treatment, 66.4% in advanced, metastatic, or terminal disease, and 39.3% after curative treatment [1]. Despite the availability of strong opioids, cancer-related pain may be inadequately controlled in up to 50% of patients [2].The armamentarium of the surgical strategies developed continuously by neurosurgeon over years is huge. This is including ablative technics, electrical neuromodulation, chemical neuromodulation at the level of the peripheral nerves, spinal cord, brainstem, thalamus, limbic system, neocortex, … making the training in the field of pain surgery a true challenge due to the diversity of the technical approaches to assimilate for pain neurosurgeon able to provide each patient with the better suited technic at the right moment.Infusion pump (specially morphine pumps) are one of the major and most powerful therapy for numerous patients. However, these pumps are not always adapted due to the location of the pain, to the infectious situation of the patient, to obstacle to the CSF flow in the spine and are expensive limiting its access to rich countries.Thus, there is still an important place for alternative interventional approaches, particularly lesioning techniques, as coming very selective in their indications and implementation, they can provide significant relief for patients. These are often older techniques, but they have become much more precise and less invasive thanks to technological advances, offering a favorable risk-benefit ratio and should therefore be applicable to a number of patients to help control their pain and so, decrease opioids and their numerous side-effects.Neuro-modulation techniques using electrical stimulation are useful in particular for pain relief after cancer treatments, which often involve a neuropathic component. The role of all these neurosurgical antalgic techniques in patients suffering from cancer pain, as well as their advantages and limitations, are described in the various chapters of this special edition, written by recognized experts in their respective fields. This is a collective work of the Frontiers of Neurosurgery Committee of the European Association of Neurosurgical Societies (EANS). We hope to provide an overview of modern cancer pain management using neurosurgical techniques, which are unfortunately still poorly known and underused, depriving a number of patients of the chance to obtain some pain relief.Jean Régis was a member of the journal’s Editorial Board at the time of submission. The authors declare there are no other conflicts of interest.The authors are declaring no relevant funding.Jean Régis and Patrick Mertens have written critically revised and approved the final manuscript.