CHAPTER 153 Pain
General Historical Considerations
Pain, originating from the Greek poine, which means penalty or punishment, has been described since the dawn of time. In Greek civilization, pain secondary to disease was believed to be caused by supernatural forces. And according to a Latin inscription attributed to Hippocrates of Kos (460-370 BC), alleviating pain was the work of the divine—sedare dolorem opus divinum est. In Greek mythology, drugs (including opium, hashish, and mandrake), magic, and even surgery were used by the gods to produce hypnosis and amnesia and heal pain. However, as the myth of the wounded immortal centaur Chiron shows, even gods would trade their divinity to avoid a life of unrelieved pain.1
The advent of the modern era in the neurosurgical management of pain can be traced to the start of the 19th century. In 1809, Walker proposed that the anterior and posterior spinal roots serve distinct motor and sensory functions.2 Bell subsequently expanded this idea,3 and Magendie in 1822 provided evidence of the role of the posterior spinal roots in the transmission of pain.4 However, it was close to another 100 years until Spiller5 and Schüller6 described the pain conduction pathways in the anterolateral columns of the spinal cord. Although debate concerning the anatomic and physiologic substrate serving pain continued, evidence for the specificity theory of pain gained momentum, and neurosurgeons exploited the existing knowledge of pain pathways to perform pain surgery, often with great success. Neurosurgeons were also quick to adapt new technology, most notably stereotaxy, radiofrequency generators, and the operating microscope, for pain procedures. A chronology of modern neurosurgical management of pain is presented in Table 153-1, which covers techniques from 1873 to 1991.
TABLE 153-1 Chronology of Modern Neurosurgical Management of Pain
| YEAR* | INVESTIGATOR | TECHNIQUE |
|---|---|---|
| 18731 | Létiévant | Neurotomies for facial and extremity neuralgias |
| 18892,3 | Abbe and Bennet | Spinal dorsal rhizotomy |
| 18914 | Horsley et al. | Gasserian ganglionectomy for trigeminal neuralgia |
| 18995 | Francois-Franck | Conception of the potential of sympathectomy |
| 19016 | Spiller and Frazier | Open trigeminal rhizotomy (middle fossa) |
| 19057 | Spiller | Spinothalamic tract in the anterolateral cord |
| 19128 | Spiller and Martin | First cordotomy |
| 19139 | Leriche | Sympathectomy for painful extremities |
| 191610 | Jonnesco | Sympathectomy for angina pectoris |
| 192211 | Läwen | Diagnostic nerve blocks |
| 192512 | Dandy | Trigeminal rhizotomy (posterior fossa) |
| 192713 | Armour | Midline commissural myelotomy |
| 193314 | Foerster | Mapping of the spinal dermatomes in humans |
| 193815 | Sjöqvist | Trigeminal tractotomy |
| 194116,17 | Schwartz and O’Leary and White | Open medullary spinothalamic tractotomy |
| 194218 | Walker | Open mesencephalic tractotomy |
| 195319 | Spiegel and Wycis | Stereotactic thalamotomy and mesencephalotomy |
| 196020 | Heath and Mickle | Deep brain (septal) stimulation for pain |
| 196021 | Mazars et al. | Thalamic (VPL) stimulation for pain |
| 196222 | Foltz and White | Bilateral cingulotomy for pain |
| 196323 | Mullan et al. | First percutaneous cordotomy |
| 196524 | Melzack and Wall | Gate theory of pain |
| 196625 | Sano et al. | Posteromedial hypothalamotomy for pain |
| 196626 | Kudo et al. | Pulvinotomy |
| 196727,28 | Jannetta | Trigeminal microvascular decompression |
| 196729 | Shealy et al. | Spinal cord stimulation |
| 196930 | Kapur and Dalton | Hypophysectomy for cancer pain |
| 197031 | Hitchcock | Extralemniscal myelotomy |
| 197232,33 | Nashold and Ostdahl and Sindou | DREZ lesions |
| 197334 | Hitchcock | Stereotactic pontine spinothalamic tractotomy |
| 197435 | Sweet and Wepsic | Radiofrequency trigeminal rhizolysis |
| 197636 | Sweet | Peripheral nerve stimulation |
| 197937 | Wang et al. | Intrathecal morphine |
| 197938 | Behar et al. | Epidural morphine |
| 198139 | Hakanson | Glycerol trigeminal chemoneurolysis |
| 198340 | Mullan and Lichtor | Trigeminal balloon microcompression |
| 199141 | Tsubokawa et al. | Motor cortex stimulation |
DREZ, dorsal root entry zone; VPL, nucleus ventroposterolateralis.
* 
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Probably the first reported procedure for the relief of pain was in 1873, when Létiévant published his description of peripheral and cranial nerve rhizotomies.7 Sectioning of the posterior spinal roots for the relief of pain in humans was first proposed by Charles Dana in 18878 and performed by Bennet9 in 1889 and also by Abbe10,11 in four patients. Otrid Foerster of Breslau, Poland, a neurologist by training, gained enough experience with the operation of posterior rhizotomy to perform it himself. Foerster later presented his landmark paper mapping the dermatomes in humans.12
Trigeminal Neuralgia
Early pain surgeons were also interested in cranial nerve pathologies, especially tic douloureux, a condition that had vexed patients and physicians alike for more than 2 centuries.13 Bell had established the trigeminal nerve as the sensory nerve for the face in 1844.14 Although Victor Horsley is credited with the first gasserian ganglionectomy and retrogasserian neurotomy in 1891,15 in truth, the contributory efforts of several other neurosurgical pioneers helped transform the management of trigeminal neuralgia. Horsley used the extradural temporal approach described by Hartley16 and Krause,17 but because his patient died, retrogasserian neurotomy was abandoned until Tiffany18 in 1896 and Spiller and Frazier19 in 1901 revived it. Dandy described the posterior fossa approach for retrogasserian neurotomy in 1925,20 although this was probably not his own original idea.21 His experience led him to conclude that subtotal section spared significant sensation without a major increase in pain recurrence.22 Although Dandy frequently observed vascular loops compressing the trigeminal nerve and, like Gardner and Miklos some 30 years later,23 suspected this to be the cause of neuralgia, Dandy did not conceive of decompression as a solution. With the introduction of better medical therapy and percutaneous procedures using the Härtel approach to the foramen ovale,24 open surgical procedures for trigeminal neuralgia fell into decline until Jannetta in 1967 reported his experience with microvascular decompression,25 a procedure that has stood the test of time.26–34
Cordotomy
Bell, with the sole aid of the naked eye and the scalpel, had also traced the posterior spinal roots up the spinal cord into the brainstem and cerebrum.14 Accurately filling in the details would take the rest of the 19th century. Both Schiff and Brown-Séquard had performed numerous experiments trying to locate the sensory tracts in the spinal cord35 when, in 1871, Müller cited a case of a stab wound involving half of the spinal cord and the opposite dorsal column that produced bilateral anesthesia for touch but caused analgesia only on the side opposite the lesion.36 Gowers later reported a case that he had seen in 1876 of a student who had shot himself through the mouth.37 The patient had intact tactile sensibility in his left limbs, but pain sensation was abolished. Postmortem examination revealed that the injury to the spinal cord was a spicule of bone that had effectively caused unilateral sectioning of the cervical cord and destroyed the continuity of the anterior and lateral columns on the right side. Gowers concluded that this part of the cord carries the fibers for the transmission of contralateral pain impulses. Edinger in 1889 demonstrated the existence of the spinothalamic tract in newborn cats and amphibians.38 It remained for Spiller, however, to prove conclusively that the spinothalamic tract carries pain and temperature impulses.5 In 1905 he described a patient with pain and temperature loss in the lower part of the body who at autopsy was confirmed to have bilateral tuberculomas involving the lower thoracic anterolateral tracts. Schüller in 1910 sectioned the anterolateral tract in monkeys.6 Martin performed the first “cordotomy” in another patient with a tuberculoma of the cord at the instigation of Spiller in 1912.39 Their short- and long-term results were encouraging and established the technique for treating intractable pain. Stookey was probably the first to perform a high cervical cordotomy in 1931 for pain in the chest and upper extremity.40 Mullan and colleagues introduced a technique for percutaneous cordotomy at the C1-2 level that involved use of a radioactive needle tip and reported it in 1963.41 The lesioning utility of radiofrequency thermocoagulation was applied to the technique by Rosomoff and coworkers,42 and cord penetration as determined by electrical impedance was described by Gildenberg and associates.43 Kanpolat and colleagues described a computed tomography–guided percutaneous procedure.44 Despite the obvious efficacy of this procedure, particularly for malignant disease and with low morbidity when performed with the most recent advances, cordotomy is unfortunately being used less and less, in part because of advances in pain management, lack of referral, and patient unwillingness to undergo ablative and potentially irreversible procedures.
Stereotaxy
Pain affecting the face, head, and shoulder could not be managed effectively by cordotomy, so open brainstem spinothalamic tractotomies were attempted.45–47 Unfortunately, the analgesic effects were short-lived, and morbidity and mortality rates were high. Spiegel and Wycis, the great pioneers of human stereotaxy, applied their technique to perform mesencephalotomy and thalamotomy with greater accuracy and success.48 Subsequently, Hitchcock introduced a stereotactic technique for pontine spinothalamic and trigeminal tractotomy.49,50
Stereotaxy not only enabled more accurate localization of targets51 but also generated important insight into the pathophysiology of chronic denervation pain.52 Lesions in the thalamic somatosensory ventrocaudal nuclei (receiving input from the neospinothalamic system) were not very successful in relieving chronic pain and were often associated with postoperative ataxia and dysesthesias.53 Attention was focused on lesioning targets of the paleoreticulospinothalamic system, especially the nonspecific intralaminar nuclei54,55 and the pulvinar,56 with greater success.
Gate Theory of Pain
A major milestone in the neurosurgical management of pain came with the publication in 1965 of Melzack and Wall’s gate theory.57 Their proposal that afferent pain transmission might be modulated by a spinal gating mechanism introduced the possibility of pain management by neuromodulation. This motivated Sweet in 1967 to perform peripheral nerve stimulation, the first augmentative procedure for pain relief.58 In 1967 Shealy and coworkers performed the first trial of spinal dorsal column stimulation.59 Heath, after observing pain relief in psychiatric patients with septal stimulation,60 repeated these results in nonpsychiatric patients in 1960.61 That same year, Mazars and associates showed that thalamic nucleus ventroposterolateralis stimulation was also effective for chronic pain.62 As stimulation technology improved, other groups confirmed these results.63,64 Encouraged by the phenomenon of stimulation-induced analgesia in animals after electrical stimulation of the periaqueductal gray matter and the suggestion that this was mediated by endogenous opioids, Richardson and Akil implanted a stimulating electrode in the periventricular gray matter in humans and reported effective pain relief.65,66 Tsubokawa and colleagues have since described the efficacy of motor cortex stimulation for deafferentation pain of thalamic origin.67
Many ablative techniques have now been supplanted by augmentative techniques. One notable exception was the introduction by Sindou in 1972 of dorsal root entry zone ablation for deafferentation pain associated with brachial plexus avulsion and traumatic paraplegia.68 This pain had remained intractable to all previously attempted ablative and augmentative techniques. Nashold and coworkers further popularized this procedure by using a radiofrequency thermocoagulation technique.69
Intraspinal Opioids
The discovery of morphine receptors in the central nervous system in 197370 and in the spinal cord in 197771 was soon followed by the display of their utility for analgesia in the spinal fluid and epidural space.72,73 Controlled opiate delivery from implanted pumps was introduced as an analgesic technique in the late 1970s for a variety of neuropathic pain syndromes and has become a mainstay neuromodulatory procedure. Pump technology has become more sophisticated, and drugs other than opioids have been delivered to the spinal fluid. Despite initial enthusiasm for this therapy, prospective studies have shown modest analgesic gains (36% of patients reported greater than 50% improvement at 2 years), and the complications of therapy have become more greatly appreciated and include catheter malfunction, catheter granulomas,74,75 and hypogonadism.76–78 The result has been a steady decline in the number of devices implanted for intrathecal opioid delivery. The expertise acquired from this complex therapy may be realized in the future with novel intrathecal drugs currently under investigation (e.g., gabapentin).
Evidence-Based Medicine
Against this backdrop, higher levels of medical evidence of efficacy have been demanded in the pain medicine literature, and the results have been sobering. In a recent review of ablative neurosurgical procedures published in the past 3 decades, level 1 evidence based on randomized clinical studies could be established only for rhizotomy for trigeminal neuralgia and facet syndromes.79 Using a similar methodology for neuromodulatory therapies to relieve non–cancer-related pain, Coffey and Lozano concluded that there has been no successful clinical study focused on establishing the efficacy of neurostimulation for pain,80 despite randomized trials comparing spinal cord stimulation with best medical management and repeated surgery. Although an inherent difficulty of trials of spinal cord stimulation is the issue of sham stimulation, most of the criticisms of trial design from this report are valid and will need to be addressed in future work. These reviews have raised the benchmark for future studies of pain relief efficacy, thus underscoring the need for investigators to provide unambiguous entry diagnosis, suitable controls who receive sham treatment, long-term follow-up, and randomization and blinding of patients, investigators, and device programmers.
Barker FG2nd, Jannetta PJ, Bissonette DJ, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077-1083.
Cetas JS, Saedi T, Burchiel KJ. Destructive procedures for the treatment of nonmalignant pain: a structured literature review. J Neurosurg. 2008;109:389-404.
Coffey RJ, Lozano AM. Neurostimulation for chronic noncancer pain: an evaluation of the clinical evidence and recommendations for future trial designs. J Neurosurg. 2006;105:175-189.
Finger S. Origins of Neuroscience: A History of Explorations Into Brain Function. New York: Oxford University Press; 2001.
Hakanson S. Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery. 1981;9:638-646.
Härtel F. Ueber die intracranielle Injektionsbehandlung der tri-geminusneuralgie. Med Klin (Munich, Germany). 1914;10:582.
Leksell L. Sterotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand. 1971;137:311-314.
Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-979.
Miller J, Acar F, Hamilton B, et al. Preoperative visualization of neurovascular anatomy in trigeminal neuralgia. J Neurosurg. 2008;108:477-482.
Sindou M, Leston J, Howeidy T, et al. Micro-vascular decompression for primary trigeminal neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir (Wien). 2006;148:1235-1245.
Sweet WH. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers: facial pain other than trigeminal neuralgia. Clin Neurosurg. 1976;23:96-102.
Ture H, Ture U, Gogus FY, et al. The art of alleviating pain in greek mythology. Neurosurgery. 2005;56:178-185.
1 Ture H, Ture U, Gogus FY, et al. The art of alleviating pain in greek mythology. Neurosurgery. 2005;56:178-185.
2 Walker A. New anatomy and physiology of the brain in particular and of the nervous system in general, 3. Arch Univ Sci. 1809.
3 Bell C. Idea of a New Anatomy of the Brain, Submitted for the Observation of His Friends. London: Strahan & Preston; 1811.
4 Magendie F. Experiences sur les fonctíons des racines des nerfs rachidiens. J Physiol Exp Pathol. 1822;2:336.
5 Spiller W. The location within the spinal cord of the fibers for temperature and pain sensations. J Nervous Mental Dis. 1905;32:318-320.
6 Schüller A. Ueber operative Durchtrennung der Rückenmarkesstränge (Chordotomie). Wien Med Wochenschr. 1910;60:2292-2296.
7 Létiévant E. Traité des sections nerveuses. Paris: JB Balliere et Fils; 1873.
8 Dana C. A clinical study of neuralgias and of the origin of reflex or transferred pains. N Y Med J. 1887;66:121-127.
9 Bennet W. A case in which acute spasmodic pain in the left lower extremity was completely relieved by subdural division of the posterior roots of certain spinal nerves. Med Chirl Soc Lond Trans. 1889;72:329-348.
10 Abbe R. A contribution to the surgery of the spine. Med Rec. 1889;35:149-152.
11 Abbe R. Intradural section of the spinal nerves for neuralgia, Vol 135. Boston: M & SJ. 1896. 329-335
12 Foerster O. The dermatomes in man. Brain. 1933;56:1-39.
13 Lewy F. The first authentic case of major trigeminal neuralgia and some comments on the history of the disease. Ann Med Hist. 1938;10:247-250.
14 Bell C. The Nervous System, 3rd ed. London: Spottiswode; 1844.
15 Horsley V, Taylor J, Colman W. Remarks on the various surgical procedures devised for the relief or cure of trigeminal neuralgia (tic douloureux). Br Med J. 1891;2:1139-1143. 1191-1193, 1249-1252
16 Hartley F. Intracranial neurectomy of the second and third divisions of the fifth nerve: a new method. N Y Med J. 1892;55:317-319.
17 Krause F. Resection des Trigeminus innerhalb der Schädelhöhle. Arch Klin Chir. 1892;44:821-832.
18 Tiffany L. Intracranial operations for the cure of facial neuralgia. Ann Surg. 1896;24:575-619. 736-748
19 Spiller W, Frazier C. The division of the sensory root of the trigeminus for the relief of tic douloureux: an experimental, pathological and clinical study, with a preliminary report of one surgically successful case. Univ Pa Med Bull. 1901;14:341-352.
20 Dandy W. Section of the sensory root of the trigeminal nerve at the pons. Bull Johns Hopkins Hosp. 1925;36:105-106.
21 Stookey B, Ransohoff J. Trigeminal Neuralgia: Its History and Treatment. Springfield, IL: Charles C Thomas; 1959.
22 Dandy W. An operation for the cure of tic douloureux: partial section of the sensory root at the pons. Arch Surg. 1929;18:687-734.
23 Gardner WJ, Miklos MV. Response of trigeminal neuralgia to decompression of sensory root; discussion of cause of trigeminal neuralgia. JAMA. 1959;170:1773-1776.
24 Härtel F. Ueber die intracranielle injektionsbehandlung der tri-geminusneuralgie. Med Klin (Munich, Germany). 1914;10:582-584.
25 Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967;26(suppl):159-162.
26 Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. 1967. J Neurosurg. 2007;107;:216-219.
27 Barker FG2nd, Jannetta PJ, Bissonette DJ, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077-1083.
28 Pollock BE, Phuong LK, Gorman DA, et al. Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg. 2002;97:347-353.
29 Sindou M, Leston J, Howeidy T, et al. Micro-vascular decompression for primary trigeminal neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir. 2006;148:1235-1245.
30 Sindou MP, Chiha M, Mertens P. Anatomical findings observed during microsurgical approaches of the cerebellopontine angle for vascular decompression in trigeminal neuralgia (350 cases). Stereotact Funct Neurosurg. 1994;63:203-207.
31 Miller J, Acar F, Hamilton B, et al. Preoperative visualization of neurovascular anatomy in trigeminal neuralgia. J Neurosurg. 2008;108:477-482.
32 Hakanson S. Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery. 1981;9:638-646.
33 Sweet WH. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers: facial pain other than trigeminal neuralgia. Clin Neurosurg. 1976;23:96-102.
34 Mullan S, Lichtor T. Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia. J Neurosurg. 1983;59:1007-1012.
35 Finger S. Origins of Neuroscience: A History of Explorations into Brain Function. New York: Oxford University Press; 2001.
36 Müller W. Beiträge zur patholocischen Anatomie und Physiologie des menschlichen Rückenmarks. Leipzig, Germany: Voss, L; 1871.
37 Gowers W. A case of unilateral gunshot injury to the spinal cord. Trans Clin Soc London. 1878;11:24-32.
38 Edinger L. Vorlesungen über den Bau der nervösen Centralorgane des Menschen und der Thiere für Aerzte und Studirende. Leipzig, Germany: FCW Vogel; 1900-1904.
39 Spiller W, Martin E. The treatment of persistent pain of organic origin in the lower part of the body by division of the anterolateral column of the spinal cord. J Am Med Assoc. 1912;58:1489-1490.
40 Stookey B. Chordotomy of the second cervical segment for relief from pain due to recurrent carcinoma of the breast. Arch Neurol Psychiatry. 1931;26:443.
41 Mullan S, Harper PV, Hekmatpanah J, et al. Percutaneous interruption of spinal-pain tracts by means of a strontium 90 needle. J Neurosurg. 1963;20:931-939.
42 Rosomoff HL, Brown CJ, Sheptak P. Percutaneous radiofrequency cervical cordotomy: technique. J Neurosurg. 1965;23:639-644.
43 Gildenberg PL, Zanes C, Flitter M, et al. Impedance measuring device for detection of penetration of the spinal cord in anterior percutaneous cervical cordotomy. Technical note. J Neurosurg. 1969;30:87-92.
44 Kanpolat Y, Deda H, Akyar S, et al. CT-guided percutaneous cordotomy. Acta Neurochir Suppl. 1989;46:67-68.
45 Schwartz H, O’Leary J. Section of the spinothalamic tract in the medulla with observations on the pathway for pain. Surgery. 1941;9:183-193.
46 Walker A. Relief of pain by mesencephalic tractotomy. Arch Neurol Psychiatry. 1942;43:284-298.
47 White J. Spinothalamic tractotomy in the medulla oblongata. Arch Surg. 1941;43:113-127.
48 Spiegel EA, Wycis HT. Mesencephalotomy in treatment of intractable facial pain. A M A Arch Neurol Psychiatry. 1953;69:1-13.
49 Hitchcock E. Stereotactic trigeminal tractotomy. Ann Clin Res. 1970;2:131-135.
50 Hitchcock E, Sotelo MG, Kim MC. Analgesic levels and technical method in stereotactic pontine spinothalamic tractotomy. Acta Neurochira. 1985;77:29-36.
51 Leksell L. Sterotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand. 1971;137:311-314.
52 Tasker RR, Kiss ZH. The role of the thalamus in functional neurosurgery. Neurosurg Clin N Am. 1995;6:73-104.
53 Tasker R, Organ L, Hawrylshyn P. The Thalamus and Midbrain of Man: A Physiological Atlas Using Electrical Stimulation. Springfield, IL: Charles C Thomas; 1982.
54 Sano K, Yoshioka M, Ogashiwa M, et al. Thalamolaminotomy. A new operation for relief of intractable pain. Confinia Neurolog. 1966;27:63-66.
55 Spiegel EA, Wycis HT, Szekely EG, et al. Combined dorsomedial, intralaminar and basal thalamotomy for relief of so-called intractable pain. J Int Coll Surg. 1964;42:160-168.
56 Kudo T, Yoshii N, Shimizu S, et al. Effects of stereotaxic thalamotomy on intractable pain and numbness. Preliminary report. Keio J Med. 1966;15:191-195.
57 Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-979.
58 Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155:108-109.
59 Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46:489-491.
60 Heath R. Studies in Schizophrenia. Cambridge, MA: Harvard University Press; 1954.
61 Heath R, Mickle W. Evaluation of seven years experience with depth electrode studies in human patients. In: Ramey E, O’Doherty D, editors. Electrical Studies in the Anesthetized Brain. New York: Harper & Row; 1960:214-247.
62 Mazars G, Roge R, Mazars Y. [Results of the stimulation of the spinothalamic fasciculus and their bearing on the physiopathology of pain.]. Rev Prat. 1960;103:136-138.
63 Adams JE, Hosobuchi Y, Fields HL. Stimulation of internal capsule for relief of chronic pain. J Neurosurg. 1974;41:740-744.
64 Hosobuchi Y, Adams JE, Rutkin B. Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Arch Neurol. 1973;29:158-161.
65 Richardson DE, Akil H. Pain reduction by electrical brain stimulation in man. Part 2: Chronic self-administration in the periventricular gray matter. J Neurosurg. 1977;47:184-194.
66 Richardson DE, Akil H. Pain reduction by electrical brain stimulation in man. Part 1: Acute administration in periaqueductal and periventricular sites. J Neurosurg. 1977;47:178-183.
67 Tsubokawa T, Katayama Y, Yamamoto T, et al. Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl. 1991;52:137-139.
68 Sindou M. Etude de la jonction radiculo-médullaire postérieure. La radicellotomie postérieure sélective dans la chirurgie de la doleur. Villeurbanne: France: University of Lyon; 1972.
69 Nashold B, Urban B, Zorub D. Phantom pain relief by focal destruction of the substantia gelatinosa of Rolando. Adv Pain Res Ther. 1976;1:950-963.
70 Pert CB, Snyder SH. Opiate receptor: demonstration in nervous tissue. Science. 1973;179:1011-1014.
71 Atweh SF, Kuhar MJ. Autoradiographic localization of opiate receptors in rat brain. I. Spinal cord and lower medulla. Brain Res. 1977;124:53-67.
72 Behar M, Magora F, Olshwang D, et al. Epidural morphine in treatment of pain. Lancet. 1979;1:527-529.
73 Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50:149-151.
74 Cabbell KL, Taren JA, Sagher O. Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. Neurosurgery. 1998;42:1176-1180.
75 Langsam A. Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. Neurosurgery. 1999;44:689-691.
76 Daniell HW. Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002;3:377-384.
77 Finch PM, Roberts LJ, Price L, et al. Hypogonadism in patients treated with intrathecal morphine. Clin J Pain. 2000;16:251-254.
78 Schneider J. Hypogonadism in men treated with chronic opioids. Arch Phys Med Rehabil. 2008;89:1414.
79 Cetas JS, Saedi T, Burchiel KJ. Destructive procedures for the treatment of nonmalignant pain: a structured literature review. J Neurosurg. 2008;109:389-404.
80 Coffey RJ, Lozano AM. Neurostimulation for chronic noncancer pain: an evaluation of the clinical evidence and recommendations for future trial designs. J Neurosurg. 2006;105:175-189.
1 Létiévant E. Traité des Sections Nerveuses. Paris: JB Balliere et Fils; 1873.
2 Abbe R. A contribution to the surgery of the spine. Med Rec. 1889;35:149-152.
3 Bennet W. A case in which acute spasmodic pain in the left lower extremity was completely relieved by subdural division of the posterior roots of certain spinal nerves. Med Chir Soc Lond Trans. 1889;72:329-348.
4 Horsley V, Taylor J, Colman W. Remarks on the various surgical procedures devised for the relief or cure of trigeminal neuralgia (tic douloureux). Br Med J. 1891;2:1139-1143. 1191-1193, 1249-1252
5 Francois-Franck: Signification physiologique de la resection du sympathetique dans la maladie de Basendour, L’epilepsie, l’idiotie et de glaucome. Bull Acad Natl Med. 1899;41:565.
6 Spiller W, Frazier C. The division of the sensory root of the trigeminus for the relief of tic douloureux: an experimental, pathological and clinical study, with a preliminary report of one surgically successful case. Univ Pa Med Bull. 1901;14:341-352.
7 Spiller W. The location within the spinal cord of the fibers for temperature and pain sensations. The J Nervous Mental Dis. 1905;32:318-320.
8 Spiller W, Martin E. The treatment of persistent pain of organic origin in the lower part of the body by division of the anterolateral column of the spinal cord. J Am Med Assoc. 1912;58:1489-1490.
9 Leriche R. De l’élongation et de la section des nerfs périvasculaires dans certains syndromes douloureux d’origine artérielle et dans quelques troubles trophiques. Lyon Chir. 1913;10:378-382.
10 Jonnesco T. Angine de poitrine guerie par la resection du sympathetique das la malady de Basendour, l’epilepsie, l’idiote, et de glaucome. (Cardiac chest pain alleviated by resection of the sympathetic system, as used in the treatment of Basendour’s disease, epilepsy, mental retardation and glaucoma). Bull Acad Natl Med. 1920;84:93-102.
11 Läwen A. Ueber segmentäre Schmerzaufhebung durch papavertebrale Novokaininjektionen zur Differentialdiagnose intra-adbominaler Erkrankungen. Med Wochenschr. 1922;69:1423.
12 Dandy W. Section of the sensory root of the trigeminal nerve at the pons. Bull Johns Hopkins Hosp. 1925;36:105-106.
13 Armour D. Surgery of the spinal cord and its membranes. Lancet. 1927;1:691-697.
14 Foerster O. The dermatomes in man. Brain. 1933;56:1-39.
15 Sjöqvist O. Studies on pain conduction in the trigeminal nerve. Acta Psychiatr Neurol Scand Suppl. 1938;17:1-139.
16 Schwartz H, O’Leary J. Section of the spinothalamic tract in the medulla with observations on the pathway for pain. Surgery. 1941;9:183-193.
17 White J. Spinothalamic tractotomy in the medulla oblongata. Arch Surg. 1941;43:113-127.
18 Walker A. Relief of pain by mesencephalic tractotomy. Arch Neurol Psychiatry. 1942;43:284-298.
19 Spiegel EA, Wycis HT. Mesencephalotomy in treatment of intractable facial pain. A M A Arch Neurol Psychiatry. 1953;69:1-13.
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