Pain is a functional disorder. It is a term for illnesses in which there is no evidence of organic disturbance or injury causing the problem even though the person is impaired. Many diagnoses can fall within the parameters of being called a functional disorder when there is no apparent reason which direct us to why the impairment is occurring. Functional neurosurgery is resorted to only after medications have failed to alleviate the situation. Functional neurosurgery may involve radiosurgery, probes or electrical stimulation.
Intractable pain is pain that has not been lessened with medication and is considered debilitating to the individual. It can be common after spinal cord injury or with certain types of cancer. When the pain system works properly, it alerts us to the danger of injury to the body. With intractable pain, a normally non-painful stimulus may be painful or a pain that should be mild is excruciating. Receptors that respond to pain are found throughout the body, but perception and response to pain take place in the brain.
With chronic intractable pain, the pain signals continue to cause discomfort for months and years. It may have started with an initial event, accident or infection or it may have started for an initial event, accident or infection or it may have started for no reason. The person, it is overwhelming. Many cannot work, socialize or sleep.
Continued pain usually results in a reliance on medications and then to depression. Thus a vicious circle begins where a person will seek multiple operations, medicines and therapies to halt or lessen the pain.
Many people in the intermediate or advanced stages of cancer suffer severe pain. Nearly 2 million people in the USA are so severely disabled from back pain they are unable to work. Over $4 billion is spent in the USA on headache medication each year. Treatments for pain range from acupuncture to electrical brain stimulation to surgery to the severance of major junctions in pain pathways.
With radiosurgery, an attempt is made to destroy part of the relay station in the brain which transmits the pain signals. This procedure is called a cingulotomy.
Pain Treatment Summaries:
The patient, a 47 year-old male, suffered from intractable lumbar back pain and was being maintained on a morphine pump. He had been subjected to numerous prior surgical procedures, including a spinal cord stimulator, without relief. He received a Gamma Knife radiosurgery cingulotomy treatment in 1995. The patient experienced enough relief to be off all of his medications and is still today enjoying normal activities. (Submitted by Dr. Aizik Wolf).
The patient is a 38-year-old female with metastatic uterine cancer to the bones and lumbosacral plexus nerves. At the intractable pelvic and leg pain which was unresponsive to intravenous and epidural morphine in large quantities. Her cancer disease was stable and she appeared to be dying of cancer pain. She received other interventions which were ineffective: cervical chordotomy, intrathecal alcohol blocks and multiple medications. She was placed under continuous IV sedation with Versed for three days and then underwent Gamma Knife radiosurgical ablation of the pituitary gland as a last resort. It is known that even partial destruction of the pituitary gland can improve cancer-induced chronic pain from hormonally dependent metastatic tumors. This procedure is normally performed either surgically or using absolute alcohol injected directly into the gland. Radiosurgical ablation was attempted in lieu of surgery because of the patient's advanced condition and low white blood cell count. The patient showed dramatic pain control within 12 hours after Gamma Knife radiosurgery. She was able to sit up in bed and eat the next day. She was discharged the following day with oral morphine and lived three months with good pain control and a better quality of life with her family. The patient did not develop any significant hormone imbalance or visual disturbance. (Submitted by Dr. Richard L. Weiner).
The Hospital Na Homolce in Prague, Czech Republic, informs us that they have presently treated 19 patients for intractable pain utilizing Gamma Knife technology. These have consisted of thalamic pain, phantom pain and atypical trigeminal neuralgia. These treatments resulted in 30 to 38 percent pain relief. (Submitted by Dr. Dusan Urgosik).
Treatment of trigeminal neuralgia for 95 patients with half having a minimum of 24 months follow-up showed results clearly based on the type of neuralgia relative to the patients' diagnoses. The breakdown follows: 81 percent of the essential neuralgia of 31 patients received excellent to very good pain relief; the 8 patients with neuralgia related to multiple sclerosis had 71 percent with very good pain relief; the atypical neuralgia group of 3 had 66 percent with very good pain relief; and the postherpetic neuralgia group of 8 had 38 percent. (Submitted by Dr. Dusan Urgosik).