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Patients and their surgeons may be so overwhelmed by the unremitting domination of serious pain that they seek a fundamental answer by surgery, aiming to cut completely the pathway that transmits the message or to destroy the hypothetical pain centre. If the ventral-lateral quadrant of the spinal cord is cut on one side, a clear analgesia appears on the opposite side of the body below the level of the cut. This loss of pain lasts for weeks and months but is replaced by even more unpleasant pains as nerve cells ahead of the cut build up their excitability. This operation is now rarely done except in some cases where cancer patients have only a short time to live. The very large improvement in the understanding of narcotic therapy for cancer pain means this has replaced the surgical attempt to cut the messages off from their destination.In intractable cases where pain fails to respond to narcotics, neurosurgeons have made lesions in many locations which were believed to be candidates for the ‘pain centre’ or for being major message-carrying bundles. The results are remarkably similar no matter where the lesion is made. Initially there is a gratifying relief from pain but, within days, weeks or months, pain returns, often with additional unpleasant characteristics. Another target of attack has been in parts of the brain classically assigned to ‘thinking’ in the old dualistic scheme. The result, as in the case of frontal lobotomy, is a patient who has considerable cognitive deficits, particularly in holding attention. These patients may appear somewhat better, even though they report that the pain is as bad as ever, because their attention, normally rivetted by their pain, drifts away onto other topics. Patients and relatives do not consider this relief worth the price.Legitimate research continues to locate cells in the brain that are firing off in abnormal patterns and creating false signals. Such cells exist in the spinal cord when motorcycle crashes rip the entering roots from the spinal cord, leaving a numb, paralyzed arm and ongoing pain generated by the spontaneous discharge of spinal-cord cells attempting to compensate for their loss of input. The problem with an operation to remove the spinal-cord cells is that, after a period of relief, cells further down the line react to the loss of input created by the surgery and take up the pain-producing activity.Other therapeutic methodsThere remain huge numbers of other methods, many of ancient origin, almost none of which have been subjected to rigorous trial and yet which retain enthusiastic advocates who proclaim their effectiveness.*57\219\2*