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Electrical stimulation of the ventral and dorsal columns of the spinal cord for relief of chronic intractable pain: preliminary report.

Serious questions are raised as to whether electrical control of pain is related to stimulation of the dorsal columns per se or the conduction of the electrical impulse via the cerebrospinal fluid to the ventrolateral columns. Percutaneous on-surface spinal cord stimulation is advocated as an accurate screening method before implantation. Of 27 patients who underwent dorsal column stimulator implants, the last three patients also underwent ventral column stimulator implants. Results in the patients with both implants tend to predict much better results with the possibility that ventral column stimulation alone is sufficient.

Back Pain

The management of intractable pain in patients with advanced malignant disease.

The Brompton mixture is a highly effective, flexible, safe and convenient means to control chronic pain of malignant disease. The mixture is a solution containing morphine, the dose of narcotic varying with the need for analgesia, and is given regularly, usually every 4 hours, with a phenothiazine. The main aims of therapy are prevention of pain rather than treatment, an unclouded sensorium and a normal effect. Terminally ill cancer patients were given the Brompton mixture and a phenothiazine in an attempt to control their pain. The mixture was administered to patients in 3 hospital environments: 1) a palliative care unit, 2) general wards and 3) private rooms. Pain was measured in 92 patients with the McGill-Melzack pain questionnaire. The Brompton mixture controlled pain in 90 per cent of patients in the palliative care unit and in 75 to 80 per cent of patients in the wards or private rooms. The differences in pain scores between patients in the palliative care unit and the other groups were significant. The mixture produced substantial decreases in the 3 major dimensions of pain: 1) sensory, 2) affective and 3) evaluative. Comparison of these results with data obtained in an outpatient pain clinic showed that the Brompton mixture was strikingly more effective than the traditional methods of managing cancer pain.

Analgesics, Opioid

Stimulation of the posterior columns of the spinal cord for relief of intractable pain.

Sixty-nine patients with chronically incapacitating pain were treated with an implantable stimulator over the posterior columns of the spinal cord. Evaluations at 24, 30 and 34 months showed a progressive decrease in the number of patients considered to have an excellent result. Evaluation of 60 patients with pain of benign origin after implantation of the stimulating device showed only ten patients who could be considered to have an excellent result on the basis of their own report of pain relief. The most common failure of the stimulating devices was failure of stimulation into a painful part.

Ankylosis

The management of intractable pain in patients with advanced malignant disease.

The Brompton mixture is a highly effective, flexible, safe and convenient means to control chronic pain of malignant disease. The mixture is a solution containing morphine, the dose of narcotic varying with the need for analgesia, and is given regularly, usually every 4 hours, with a phenothiazine. The main aims of therapy are prevention of pain rather than treatment, an unclouded sensorium and a normal effect. Terminally ill cancer patients were given the Brompton mixture and a phenothiazine in an attempt to control their pain. The mixture was administered to patients in 3 hospital environments: 1) a palliative care unit, 2) general wards and 3) private rooms. Pain was measured in 92 patients with the McGill-Melzack pain questionnaire. The Brompton mixture controlled pain in 90 per cent of patients in the palliative care unit and in 75 to 80 per cent of patients in the wards or private rooms. The differences in pain scores between patients in the palliative care unit and the other groups were significant. The mixture produced substantial decreases in the 3 major dimensions of pain: 1) sensory, 2) affective and 3) evaluative. Comparison of these results with data obtained in an outpatient pain clinic showed that the Brompton mixture was strikingly more effective than the traditional methods of managing cancer pain.

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