Destructive procedures for control of cancer pain: the case for cordotomy
Bibliographic record
Abstract
OBJECT: Historically, destructive procedures for cancer pain were the main line of treatment therapy. However, the use of high-dose opioids has essentially replaced such procedures. Recognition of the limits of medical therapy to treat cancer pain effectively is growing, while conversely, in regions with limited access to pain medications, the importance of destructive surgical techniques is increasing. A critical evaluation of the evidence for destructive techniques is warranted, and the authors review current evidence underlying these procedures. METHODS: A US National Library of Medicine PubMed search for "ablation," "DREZ," "dorsal root entry zone," "cingulotomy," "cordotomy," "ganglionectomy," "mesencephalotomy," "myelotomy," "neurotomy," "neurectomy," "rhizotomy," "sympathectomy," "thalamotomy," "tractotomy," and "pain" was undertaken. The search was then limited to human studies, English-language literature, cancer pain, and reports with more than 1 patient. RESULTS: One hundred twenty papers were identified and reviewed based on the selection criteria described. According to the Canadian and US task forces, classification of clinical research literature only "sympathectomy" was supported by Class I or II studies, with 2 Class I papers and 1 Class II paper identified for cancer pain. All other procedures were supported by Class III studies of variable quality. Cordotomy in particular was the most extensively studied and reviewed procedure. Given the large number of patients studied, consistent results, multiplicity of reports and, even though evidence quality for individual studies was relatively low, cumulative evidence suggests that cordotomy may play an important role in the treatment of cancer pain. CONCLUSIONS: Destructive procedures for cancer pain may play more than a historic role in the management of cancer pain. Cumulative evidence from even the poorest quality studies suggests that some procedures, such as cordotomy, should be included in the armamentarium available to the neurosurgeon today. To renew appropriate interest in these procedures, evidence and studies that meets today's evidence-based research criteria are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.003 | 0.007 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".