The Neurosurgical Management of Intractable Pain

Abstract

The management of intractable pain can represent a sore trial for the patient and the physician alike. To the patient presenting himself with this common symptom, it is usually the most significant phase of his ailment and the one from which he desires most to be relieved, regardless of its cause. To make a diagnosis and to make the patient comfortable while directing attention to the elimination or amelioration of the cause of the pain should be almost axiomatic with the physician. Hypnotics and analgesics have been used with varying degrees of relief in the individual case. Employed often in near-lethal doses to accomplish the desired effect, the penalties of prolonged usage often outweigh the benefit of their administration. Hence the application of neurosurgical measures in certain cases affords a more satisfactory solution, both from the standpoint of the patient and of the physician. Interruption of the pain conduction pathways forms the usual basis of this type of treatment.

The neurosurgical management of headache due to encroachment upon the cranial cavity by mass lesions such as tumor, abscess, subdural and extradural hematomas or hydroma resolves itself largely into a problem of removing the offending agent when possible, or resorting to decompression measures when their removal is impossible. This form of pain is due to the disturbed intracranial fluid dynamics and relief is obtained by re-establishing as relatively normal fluid relations within the skull as is possible. Of somewhat different mien is the post-traumatic or post-inflammatory headache, when often no alteration. . .