The management of central and peripheral neuropathic pain remains a daunting challenge for pain physicians in general and the functional neurosurgeon in particular. The reasons are manifold. Pharmacological advances in the management of neuropathic pain have been glacial with the only relatively new developments being the use of antiepileptics and antidepressants. Furthermore, the subset of these patients who present to the neurosurgeon have had this distressing pain for a long period of time and, having usually tried and failed numerous pain medications over this period of time, have developed psychological overlays such as depression, hopelessness, anxiety, personality disorders, and substance abuse issues.