Punctate midline myelotomy for the relief of visceral cancer pain

Haring J W Nauta, Vicki M. Soukup, Roderic H. Fabian, James T. Lin, James J. Grady, Courtney Williams, Gerald Campbell, Karin N. Westlund, William D. Willis

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Object. This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies. Methods. A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination. Conclusions. These findings provide corroborating clinical evidence for the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.

Original languageEnglish (US)
Pages (from-to)125-130
Number of pages6
JournalJournal of Neurosurgery
Volume92
Issue number2 SUPPL.
StatePublished - Apr 2000

Fingerprint

Visceral Pain
Narcotics
Pain
Neoplasms
Pelvic Pain
Drug and Narcotic Control
Abdominal Pain
Autopsy
Spinal Cord
Therapeutics
Cancer Pain
Morbidity

Keywords

  • Cancer pain
  • Myelotomy
  • Pain pathway
  • Posterior columns
  • Visceral pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Nauta, H. J. W., Soukup, V. M., Fabian, R. H., Lin, J. T., Grady, J. J., Williams, C., ... Willis, W. D. (2000). Punctate midline myelotomy for the relief of visceral cancer pain. Journal of Neurosurgery, 92(2 SUPPL.), 125-130.

Punctate midline myelotomy for the relief of visceral cancer pain. / Nauta, Haring J W; Soukup, Vicki M.; Fabian, Roderic H.; Lin, James T.; Grady, James J.; Williams, Courtney; Campbell, Gerald; Westlund, Karin N.; Willis, William D.

In: Journal of Neurosurgery, Vol. 92, No. 2 SUPPL., 04.2000, p. 125-130.

Research output: Contribution to journalArticle

Nauta, HJW, Soukup, VM, Fabian, RH, Lin, JT, Grady, JJ, Williams, C, Campbell, G, Westlund, KN & Willis, WD 2000, 'Punctate midline myelotomy for the relief of visceral cancer pain', Journal of Neurosurgery, vol. 92, no. 2 SUPPL., pp. 125-130.
Nauta HJW, Soukup VM, Fabian RH, Lin JT, Grady JJ, Williams C et al. Punctate midline myelotomy for the relief of visceral cancer pain. Journal of Neurosurgery. 2000 Apr;92(2 SUPPL.):125-130.
Nauta, Haring J W ; Soukup, Vicki M. ; Fabian, Roderic H. ; Lin, James T. ; Grady, James J. ; Williams, Courtney ; Campbell, Gerald ; Westlund, Karin N. ; Willis, William D. / Punctate midline myelotomy for the relief of visceral cancer pain. In: Journal of Neurosurgery. 2000 ; Vol. 92, No. 2 SUPPL. pp. 125-130.
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