Thalamotomy for Control of Chronic Pain
For the past several years I have attempted to develop a stereotaxic procedure at the level of the thalamus for control of chronic pain. A stereotaxic operation has several theoretical advantages over older procedures such as rhizotomy, tractotomy, and prefrontal lobotomy for pain. Firstly, procedures at this level would control pain over the entire contralateral half of the body and would not be limited to anatomical segments, which would be helpful in difficult areas of pain control such as craniocervical pain. Secondly, stereotaxic procedures can be performed easily under local anesthesia, obviating the use of general anesthesia and prolonged open operations on patients who are often debilitated with advanced cancer. Thirdly, on theoretical grounds, at the level of the thalamus sensation should be segregated into its different components of touch, proprioception, temperature, and pain; allowing preferential destruction of pain in the conducting system without the associated loss of sensation of other types. Fourth, anatomical separation from the motor and other systems reduce the complications of weakness, ataxia, and incontinence, that are not uncommonly seen after tractotomy in the spinal cord or brain stem. Lastly, it should not have the destructive effect on personality associated with prefrontal lobotomy.
KeywordsChronic Pain Centre Median Reticular Formation Somatosensory Input Spinothalamic Tract
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- 2.Bishop, Landau, W. M. (1958), Evidence for a double peripheral pathway for pain. Science 128, 712–713.Google Scholar
- 4.Bowsher, Petit, D., Malbart, G., Able-Fessard, D. (1968), A bulbar relay to the centre median. J. Neurophysiol. 31, 288 300.Google Scholar
- 6.Collins, O’Leary, J. L. (1954), Study of a somatic evoked response in the midbrain reticular substance. EEG clin. Neurophysiol. 6, 619–628.Google Scholar
- 7.Collins, W. F., Randt, C. T. (1958), Evoked central nervous system activity relating to peripheral unmyelinated or C fibers in cat. J. Neurophysiol. 21, 345–352.Google Scholar
- 8.Landau, W., Bishop, G. H. (1953), Pain from dermal, periosteal and fascial endings and from inflammation. Arch. Neurol. Psychiat. 69, 490–594.Google Scholar
- 9.Mark, V. H., Ervin, F. R., Yarkovlen, P. I. (1971), Correlation of pain relief, sensory loss, and anatomical lesion sites in pain patients treated by stereotaxic thalamotomy. Trans. Am. Neuro. Ass. 86, 86–90.Google Scholar
- 11.Mehler, W. R. (1962), The anatomy of the so-called “pain tract” in man: An analysis of the course and distribution of the ascending fibers of fasiculus anterolateralis. Basic Research in Paraplegia, pp. 26–55. Charles C Thomas.Google Scholar
- 13.Petren, K. (1960), Über die Balmung der Sensitivität im Rückenmark besonders nach dem Fallen von Strichverletzung studiert. Arch. Psychiat. 47, 495.Google Scholar
- 14.Richardson, D. E. (1972), Sensory function of the pulvinar. Symposium on the Pulvinar St. Barnabar Hosp. N.Y., in press.Google Scholar
- 15.Richardson, D. E. (1972), Stereotaxic cingulumotomy and prefrontal lobotomy in mental disease. South. Med. J., in press.Google Scholar
- 17.Richardson, D. E. (1967), Thalamotomy for intractable pain. Confin. Neurol. 29, 139 145.Google Scholar