Intracranial stereotactic procedures in the central nervous system for the treatment of medically refractory chronic pain have evolved over the years. Neuroablative lesions have become a rare treatment for chronic pain, primarily because of the advent of more effective pharmacotherapy and intrathecal drug delivery. Lesion generation has the advantage of being less costly and having none of the hardware-related side effects of deep brain stimulation but the disadvantage of not being modifiable or reversible when the lesion has been generated. Although neuroablative procedures typically result in short-lived pain relief and the possibility of deafferentation pain, these procedures are still useful in certain clinical settings. The indications, methods employed, and outcome for these procedures are covered in this article.