Dec. 27, 2025
Cancer pain is often undertreated. The standard approaches to pain management also often entail debilitating side effects or provide only transient relief. For select patients, Mayo Clinic offers neurosurgical options that can enhance quality of life.
"Surgery for cancer pain is heavily underutilized. We need to do a better job of getting these patients to a surgeon in a timely manner," says Rushna P. Ali, M.D., a functional neurosurgeon at Mayo Clinic in Rochester, Minnesota.
Managing cancer pain historically has focused on high-dose opioids for people with short-term expected survival. But advances in oncologic care mean more people are living longer with cancer. Even patients considered disease-free can experience chronic pain, including postsurgical syndromes and chemotherapy-induced peripheral neuropathic pain.
"About 30% to 40% of these patients with life expectancy of five years or more continue to deal with severe cancer-related pain — though this is likely an underestimation," Dr. Ali says. "That pain has a significant impact on quality of life."
Neuromodulation can provide relief for patients with life expectancy of at least six months. Patients with shorter expected survival can benefit from lesioning procedures that short-circuit pain pathways.
"We don't want patients in their last six months to be in miserable pain or in an opioid-induced haze and unable to spend quality time with their loved ones," Dr. Ali says. "The latest statistics show that about half of cancer patients die in pain. We haven't made a meaningful improvement in their quality of life in their last days."
Centered on patient care
Cancer pain can be nociceptive or neuropathic, arising from nerve injury due to the underlying cancer or the effects of chemotherapy or radiation therapy. Medication is generally the first treatment choice. But side effects can limit patients' ability to live functional, productive lives.
Local nerve blocks are another typical option. "Although the effects of those treatments can last weeks or sometimes months, the pain always comes back," Dr. Ali says. "The blocks can be repeated, but their efficacy continues to decrease."
At Mayo Clinic, patients seeking surgical options undergo multidisciplinary evaluations to determine the type and location of their pain. That information, combined with patients' cancer prognoses, helps determine treatment.
"Our surgical approach is tailored to the patient," Dr. Ali says. "For patients with a life expectancy of six months or more, we typically want surgery that is less invasive and will have a longer lasting benefit."
"Surgery for cancer pain is heavily underutilized."
Neuromodulation fits those criteria. Surgically implanted pumps can deliver intrathecal pain medication. Surgically implanted spinal cord stimulators can block pain signals from reaching the brain.
"We perform a short surgery, called a trial, to determine a patient's eligibility for a pain pump or spinal cord stimulator," Dr. Ali says. "We either inject medications directly in the patient's spinal fluid or place electrodes atop the spinal cord. We know soon afterwards if the patient will respond to that type of surgery. If so, we can do a permanent implantation. Often for these patients, one can make the argument to skip the trial and go directly to permanent implant."
She notes that pain pumps deliver morphine or other medications directly to patients' relevant pain receptors. "The patient gets a continuous infusion of medication that isn't absorbed by the body," Dr. Ali says. "It's the same benefit as taking oral morphine but with a much smaller dose and without the sides effects that come with taking a pill or having an injection."
A more aggressive surgical approach might be used for patients with lower life expectancy. "Lesioning procedures can be helpful," Dr. Ali says. "We can address pain regardless of location, after doing a thorough review to see if a patient is a candidate for this type of surgery."
Patients generally respond well to surgical treatment for cancer pain. "Typically, these patients start off with severe pain. With the appropriate intervention, that pain can be brought to milder levels," Dr. Ali says.
Timely referral to a neurosurgeon increases the likelihood that a patient will qualify for surgical treatment.
"Any type of cancer, whether it's local or widespread, can lead to chronic intractable pain," Dr. Ali says. "That pain is often considered to be part and parcel of the cancer diagnosis. We haven't been very aggressive about making sure these patients aren't neglected. That is where we miss the mark."
For more information
Refer a patient to Mayo Clinic.