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For noncancer pain, ablative procedures such as dorsal root entry zone lesions and rhizolysis for trigeminal neuralgia (TN) should continue to be practiced. Other procedures, such as medial thalamotomy, have not been proven effective and require continued study. Dorsal rhizotomy, dorsal root ganglionectomy, and neurotomy should probably be abandoned. For cancer pain, cordotomy is an important and underutilized method for pain control. Intrathecal opiate administration via an implantable system remains an important option for cancer pain management. While there are encouraging results in small case series, cingulotomy, hypophysectomy, and mesencephalotomy deserve further detailed analysis. Electrical neuromodulation is a rapidly changing discipline, and new methods such as high-frequency spinal cord stimulation (SCS), burst SCS, and dorsal root ganglion stimulation may or may not prove to be more effective than conventional SCS. Despite a history of failure, deep brain stimulation for pain may yet prove to be an effective therapy for specific pain conditions. Peripheral nerve stimulation for conditions such as occipital neuralgia and trigeminal neuropathic pain remains an option, although the quality of outcomes data is a challenge to these applications. Based on the evidence, motor cortex stimulation should be abandoned. TN is a mainstay of the surgical treatment of pain, particularly as new evidence and insights into TN emerge. Pain surgery will continue to build on this heritage, and restorative procedures will likely find a role in the armamentarium. The challenge for the future will be to acquire higher-level evidence to support the practice of surgical pain management.<\/jats:p>","DOI":"10.3171\/2019.1.jns181620","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T20:01:07Z","timestamp":1554840067000},"page":"1039-1049","source":"Crossref","is-referenced-by-count":52,"title":["Contemporary concepts of pain surgery"],"prefix":"10.3171","volume":"130","author":[{"given":"Kim J.","family":"Burchiel","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Raslan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1159\/000113872","article-title":"Pain relief after cervical ganglionectomy (C2 and C3) for the treatment of medically intractable occipital neuralgia","volume":"86","author":"Acar F","year":"2008","unstructured":"Acar F, Miller J, Golshani KJ, Israel ZH, McCartney S, Burchiel KJ: Pain relief after cervical ganglionectomy (C2 and C3) for the treatment of medically intractable occipital neuralgia. 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