oa South African Medical Journal - Studies on pain : III : some observations on surgical treatment in 65 cases
(Concluded from p. 715) Sixty-five instances of attempts at relief of severe pain by various surgical procedures have been reported. The following tentative conclusions seem justifiable: The least satisfactory results attend interruption of peripheral nerves. Posterior rhizotomy is strongly contra-indicated if it denervates a significant part of a limb. Interruption of spino-thalamic pain conducting pathways is a most useful procedure, provided it is carried out at a level sufficiently high above the pain-initiating lesion, and in the absence of certain definite contraindications. The ill-effects of chordotomy have been exaggerated, but the patient must be instructed to empty the bladder at regular intervals. Temporary chemical interruption of sympathetic pathways may significantly break a cycle of pain. Operative sympathetomy must be complete for the affected part. Pain may recur after adequate prefrontal leucotomy. In selecting methods of pain-relief surgery, the expectation of life in a given case is most important. A potent cause of failure is inadequate denervation. The ï¿½psychologicalï¿½ make-up of the patient is perhaps an important cause of failure.
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