Rethinking When to Refer for Pain Surgery: Nester Tomycz, MD

WATCH TIME: 4 minutes

"Too often, we don’t see these patients until their pain is debilitating and they've failed everything else. Earlier neurosurgical intervention—especially for things like diabetic neuropathy—can improve outcomes, reduce medication use, and prevent long-term disability. But the system makes early access difficult."

Chronic pain is a widespread and debilitating condition defined as pain that persists for more than 3 months, often beyond the normal course of healing. It can result from injury, surgery, nerve damage, or be associated with conditions like arthritis, fibromyalgia, or neuropathy. According to the CDC, over 51 million adults in the United States live with chronic pain, and of those, about 17 million experience high-impact chronic pain.

For patients with refractory or severe chronic pain who do not respond to medications, physical therapy, or less invasive interventions, neurosurgical techniques can offer meaningful relief. These surgical approaches include spinal cord stimulation, intrathecal drug delivery systems, deep brain stimulation, dorsal root ganglion stimulation, and cordotomy or myelotomy, among others. Over the years, the treatment pathways for chronic pain have evolved significantly, moving from a primarily pharmacologic and acute-care focus to a more multidisciplinary, individualized, and mechanism-based approach.

To gain greater insights on the continual evolution of treating chronic pain, NeurologyLive^® sat down with Nester Tomycz, MD, director of neurosurgical pain division at Allegheny Health Network. In the interview, Tomycz emphasized the need for earlier surgical intervention and improved patient awareness of neuromodulation techniques such as spinal cord stimulation. Furthmore, he highlighted the systemic barriers clinicians face–such as insurance requirements and procedural hurdles–that often delay access to surgical options, even when early intervention could improve outcomes.