Electrostimulation and Neurosurgical Measures in Cancer Pain

Abstract

In 1975 Gildenberg [1] published the results of a survey of the procedures used to combat pain by 1998 neurosurgeons in the United States and Canada. Approximately 2000 percutaneous cordotomies, 135 thalamotomies, 20 mesencephalotomies, 40 cingulotomies, and 24 implantations of stimulating electrodes were performed annually. It is difficult to speculate on to day’s figures, but thalamotomies, mesencephalotomies, and cingulotomies are probably almost no longer performed. Percutaneous cordotomies are considered even more rarely following the tremendous development of stimulating techniques and the epidural/intrathecal or ventricular application of morphine or morphine-like substances. If 10 years ago neurosurgical techniques had already been markedly improved by the use of percutaneous techniques like cervical cordotomies and sterotactic thalamotomies or mesencephalotomies (without general anaesthesia, without loss of blood, with minmal stress for the patient, and with short hospitalization), in the last few years new advances in the field of pain physiology have modified our neurosurgical therapeutic spectrum still further. In the choice of operation it is of decisive importance to distinguish between neurogenic (deafferentation) pain and somatogenic pain. Neurogenic pain is taken to mean pain (mainly a burning sensation) in an area of disturbed sensitivity, e.g. pain due to invasion of nerve roots by the cancer or to radiation or surgical damage of nervous structures. Somatogenic pain occurs because of irritation of pain receptors, e.g., bone pain in bone metastases.