Sampson Lipton

Phantom limb pain treated by electrical stimulation

&NA; Twenty patients suffering from phantom limb pain were assessed for suitability for treatment by electrical stimulator implant to the peripheral nerve or the spinal cord. Twelve were so treated and seven obtained excellent and three partial relief of pain. One patient maintains excellent relief of pain by transcutaneous electrical stimulation. Factors that might influence the responsiveness of pain to electrical stimulation and the qualitative results from such treatment are discussed.

TREATMENT OF INTRACTABLE PAIN BY ACUPUNCTURE

Abstract A series of eighteen well-documented cases of intractable pain, resistant to orthodox procedures, were treated by acupuncture. Most were relieved for varying periods, and six are described in detail.

Pituitary injection of alcohol for widespread cancer pain

&NA; Moriccas technique of the pituitary injection of alcohol has been performed 155 times on 92 patients at the Centre for Pain Relief, Walton Hospital, Liverpool. There were 4 post‐operative deaths within the first week. The technique is considered to be an exceedingly useful method of reviewing pain in patients suffering from widespread inoperable cancer. 40% of the patients treated had complete relief of their pain, half of these (20%) having complete relief for at least 4 months. 30% of the patients treated had some relief of pain and 30% had none. During injection, it was noted that Myodil injected before the alcohol spread along the pituitary stalk and the walls of the third ventricle. It eventually broke through into the third ventricle. It is postulated that the alcohol follows this route and the relief of pain is due to destruction of thalamic and hypothalamic nerve pathways.

PAIN RELIEF BY IMPLANTED ELECTRICAL STIMULATORS

Abstract Experience in eleven patients treated by electrical stimulation using implanted electrodes, highlights the considerable difficulty in the selection of cases. Careful investigation should make it possible to predict suitability, and percutaneous posterior column stimulation would seem to be an obligatory step. Considerable success can be expected in certain syndromes, notably phantom-limb pain. The relative suitability of many other syndromes is not known. Assessment and treatment by this method is at present very time-consuming and requires the special knowledge of many different disciplines. At this stage it seems sensible to concentrate effort on evaluating the method rather than on encouraging widespread and possibly indiscriminate use of what is an expensive and relatively unproven technique.

Anatomical correlations in human cutaneous pin-prick analgesia and pain relief following unilateral cervical cordotomy

AIM OF INVESTIGATION: The precise location and extent in the transverse nlane of a lesion in the C, sninal segment reauired to Droduce con&lateral analgesia in man hfs not been-defined-accurately. This study attempts to establish the area whose destruction is necessary to achieve this. METHOD: Histological preparations of stained transverse sections of the C2 segment from 18 patients who underwent unilateral percutaneous cervical radiofrequency cordotomy were studied. The maximal area of tissue destruction was determined by microscopic inspection, outlines of the sections containing the lesions were drawn and transferred to a standard representation of the C2 segment using some referential anatomical landmarks. The area of the lesion so established was correlated with the extent of the cutaneous loss of pin-prick sense and the degree of pain relief produced by the procedure in shortand longsurvival groups of patients. REsuI1ps: A defined area in the anterolateral funiculus whose desan produces analgesia in man was determined. Its posterior border is roughly level with the dentate ligament. Destruction of the anterior funiculus does not seem necessary to obtain analgesia. A somatotopic pattern, caudal segments being medial and posterior, was confirmed. CONCLUSION: Nociceptive fibres in man are somatotopically arranged and concentrated in the anterolateral funiculus of C2.

Percutaneous Radio Frequency Gangliolysis in the Treatment of Trigeminal Neuralgia

37 procedures were carried out in 32 patients with trigeminal neuralgia who were unrelieved by anticonvulsants. Initial relief was achieved in 31 patients (98%). 5 patients (16%) suffered a relapse during a follow-up period of 15-26 months. Corneal anaesthesia occurred in 6 patients, 1 of whom subsequently developed a corneal ulcer. Anaesthesia dolorosa appeared in 5 patients. Ipsilateral reduction in hearing was reported by 2 patients. Despite its limits and complications percutaneous radio frequency gangliolysis is an effective alternative in the treatment of trigeminal neuralgia.