Cutting or Destruction of Nervous Tissue
Surgical cutting or destruction of peripheral or central nervous tissue is now rarely used in the treatment of pain. Procedures include neurectomy, cordotomy, dorsal root entry zone lesioning, and cingulotomy.
Neurectomy involves cutting a nerve, and is (rarely) used in patients with short life expectancy who are unsuitable for drug therapy due to ineffectiveness or intolerance. The dorsal root or dorsal root ganglion (that carry mostly sensory signals) may be usefully targeted (called rhizotomy); with the dorsal root ganglion possibly the more effective target because some sensory fibers enter the spinal cord from the dorsal root ganglion via the ventral (motor) root, and these would not be interrupted by dorsal root neurectomy. Because nerves often carry both sensory and motor fibers, motor impairment is a possible side effect of neurectomy. A common result of this procedure is "deafferentation pain" where, 6–9 months after surgery, pain returns at greater intensity.
Cordotomy involves cutting into the spinothalamic tracts, which run up the front/side (anterolateral) quadrant of the spinal cord, carrying heat and pain signals to the brain (fig. 6). Pancoast tumor pain has been effectively treated with dorsal root entry zone (DREZ) lesioning – damaging a region of the spinal cord where peripheral pain signals cross to spinal cord fibers. This is major surgery, carrying the risk of significant neurological side effects. Cingulotomy involves cutting the fibers that carry signals directly from the cingulate gyrus to the entorhinal cortex in the brain. It reduces the unpleasantness of pain (without affecting its intensity), but may have cognitive side effects.
Read more about this topic: Interventional Pain Medicine
Famous quotes containing the words cutting, destruction, nervous and/or tissue:
“This man was very clever and quick to learn anything in his line. Our tent was of a kind new to him; but when he had once seen it pitched, it was surprising how quickly he would find and prepare the pole and forked stakes to pitch it with, cutting and placing them right the first time, though I am sure that the majority of white men would have blundered several times.”
—Henry David Thoreau (1817–1862)
“Though castles topple on their warder’s heads,
Though palaces and pyramids do slope
Their heads to their foundations; though the treasure
Of nature’s germens tumble all together,
Even till destruction sicken—answer me
To what I ask you.”
—William Shakespeare (1564–1616)
“A two-week-old infant cries an average of one and a half hours every day. This increases to approximately three hours per day when the child is about six weeks old. By the time children are twelve weeks old, their daily crying has decreased dramatically and averages less than one hour. This same basic pattern of crying is present among children from a wide range of cultures throughout the world. It appears to be wired into the nervous system of our species.”
—Lawrence Kutner (20th century)
“Whether or not his newspaper and a set of senses reduced to five are the main sources of the so-called “real life” of the so- called average man, one thing is fortunately certain: namely, that the average man himself is but a piece of fiction, a tissue of statistics.”
—Vladimir Nabokov (1899–1977)