Intrathecal chlorocresol. A comparison with phenol in the treatment of intractable pain.
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Hitchcock's original method of hypothermic subarachnoid irrigation employed both temperature and osmolarity. Spinal cooling was then abandoned in favour of intrathecal injection of normothermic hypertonic salilne. Modifications of the procedure that followed have continued to accept hyperosmolarity as the factor causing pain relief. Fifty patients were treated by a technique evolved to enhance the effect of hypothermia while avoiding the complications associated with hyperosmolar solutions. For the cases of terminal carcinoma and others considered to be poor surgical risks, the results have been quite satisfactory. For non-neoplastic painful syndromes, rapid perfusion cooling of the subarachnoid space offers an alternative therapeutic approach.
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The clinical management of painful conditions has seen great changes and improvements over the past two decades brought about, in a large part, by re-evaluating the basic theories on which we base our clinical practice. At the beginning of this century, we still believed in the model of pain transmission first expressed by Descartes, over 300 years ago. In the mid-1960s, a re-examination of transmission of pain was first promulgated and popularized. The Gate Control Theory of Melzak and Wall revolutionized the way we think about pain, and consequentially, the way we have come to treat it.
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The bucco-pharyngeal region is a predominant site for functional, non lesional pain syndromes associated with "abnormal" habits (often tics), which are themselves due to an anxiety related psychological disorders. These extremely common syndromes, often in the form of a self-perpetuating "vicious circle", include two types of pain: mucosal pain and fatigue myalgia. Psychotherapy is generally the appropriate treatment.
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