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SURGICAL RELIEF OF PAIN IN PARAPLEGIC PATIENTS

SURGICAL RELIEF OF PAIN IN PARAPLEGIC PATIENTS Abstract FROM the recent worldwide conflict approximately 2,000 persons returned to this country with severe injuries to the spinal cord and spinal nerves. Of these, some 600 have been under our care for varying periods. Recent years have brought the wholesale discard of older concepts of paraplegic care, and the life expectancy of the average patient with severe injury of the spinal cord has been lengthened from about eighteen months to perhaps a normal one. In consequence of the renewed hope for this type of patient, the administration of drugs which produce addiction for the relief of pain can no longer be countenanced. It is our firm belief that pain can kill, if not outright as in a case recorded by Tinsley,1 then at least insidiously through its continued action in bringing about starvation. For the purpose of simplification, pain in the paraplegic patient can be classified into three types. References 1. Tinsley, M.: Compound Injuries of the Spinal Cord , J. Neurosurg. 3: 306-309 ( (July) ) 1946.Crossref 2. Fay, T., and Gotten, N.: Controlled Spinal Anesthesia: Its Value in Establishing Appropriate Levels for Chordotomy , Arch. Neurol. & Psychiat. 30: 1276-1281 ( (Dec.) ) 1933. 3. Dogliotti, A. M.: Traitement des syndromes douloureaux de la périphérie par l' alcoolisation sub-arachnoïdienne des racines postérieurs à leur émergence de la moelle épinierè , Presse méd. 39:1249-1252 ( (Aug. 22) ) 1931. 4. Peet, M. M.; Woods, W. W., and Braden, S.: The Surgical Treatment of Hypertension: Results in Three Hundred and Fifty Consecutive Cases Treated by Bilateral Subdiaphragmatic Splanchnicectomy and Lower Dorsal Ganglionectomy , J. A. M. A. 115:1875-188 ( (Nov. 30) ) 1940. 5. Adson, A. W., and Brown, G. E.: Treatment of Raynaud's Disease by Lumbar Ramisection and Ganglionectomy and Perivascular Sympathetic Neurectomy of the Common Iliacs , J. A. M. A. 84:1908-1910 ( (June 20) ) 1925. 6. Smithwick, R.: Surgical Intervention on the Sympathetic Nervous System for Peripheral Vascular Disease , Arch. Surg. 40:286-306 ( (Feb.) ) 1940. 7. Frazier, C. H.: Section of the Anterolateral Columns of the Spinal Cord for Relief of Pain: A Report of Six Cases , Arch. Neurol. & Psychiat. 4:137-147 ( (Aug.) ) 1920. 8. (a) Kahn, E. A.: Anterolateral Chordotomy for Intractable Pain , J. A. M. A. 100:1925-1928 ( (June 17) ) 1933. 9. (b) Hyndman, O. R., and Van Epps, C.: Possibility of Differential Section of the Spinothalamic Tract: A Clinical and Histologic Study , Arch. Surg. 38:1036-1053 ( (June) ) 1939. 10. Davis, L.; Hart, J. T., and Crain, R. C.: The Pathway for Visceral Afferent Impulses Within the Spinal Cord: II. Experimental Dilatation of the Biliary Ducts , Surg., Gynec. & Obst. 48:647-651 ( (May) ) 1929. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

SURGICAL RELIEF OF PAIN IN PARAPLEGIC PATIENTS

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Publisher
American Medical Association
Copyright
Copyright © 1947 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1947.01230080441005
Publisher site
See Article on Publisher Site

Abstract

Abstract FROM the recent worldwide conflict approximately 2,000 persons returned to this country with severe injuries to the spinal cord and spinal nerves. Of these, some 600 have been under our care for varying periods. Recent years have brought the wholesale discard of older concepts of paraplegic care, and the life expectancy of the average patient with severe injury of the spinal cord has been lengthened from about eighteen months to perhaps a normal one. In consequence of the renewed hope for this type of patient, the administration of drugs which produce addiction for the relief of pain can no longer be countenanced. It is our firm belief that pain can kill, if not outright as in a case recorded by Tinsley,1 then at least insidiously through its continued action in bringing about starvation. For the purpose of simplification, pain in the paraplegic patient can be classified into three types. References 1. Tinsley, M.: Compound Injuries of the Spinal Cord , J. Neurosurg. 3: 306-309 ( (July) ) 1946.Crossref 2. Fay, T., and Gotten, N.: Controlled Spinal Anesthesia: Its Value in Establishing Appropriate Levels for Chordotomy , Arch. Neurol. & Psychiat. 30: 1276-1281 ( (Dec.) ) 1933. 3. Dogliotti, A. M.: Traitement des syndromes douloureaux de la périphérie par l' alcoolisation sub-arachnoïdienne des racines postérieurs à leur émergence de la moelle épinierè , Presse méd. 39:1249-1252 ( (Aug. 22) ) 1931. 4. Peet, M. M.; Woods, W. W., and Braden, S.: The Surgical Treatment of Hypertension: Results in Three Hundred and Fifty Consecutive Cases Treated by Bilateral Subdiaphragmatic Splanchnicectomy and Lower Dorsal Ganglionectomy , J. A. M. A. 115:1875-188 ( (Nov. 30) ) 1940. 5. Adson, A. W., and Brown, G. E.: Treatment of Raynaud's Disease by Lumbar Ramisection and Ganglionectomy and Perivascular Sympathetic Neurectomy of the Common Iliacs , J. A. M. A. 84:1908-1910 ( (June 20) ) 1925. 6. Smithwick, R.: Surgical Intervention on the Sympathetic Nervous System for Peripheral Vascular Disease , Arch. Surg. 40:286-306 ( (Feb.) ) 1940. 7. Frazier, C. H.: Section of the Anterolateral Columns of the Spinal Cord for Relief of Pain: A Report of Six Cases , Arch. Neurol. & Psychiat. 4:137-147 ( (Aug.) ) 1920. 8. (a) Kahn, E. A.: Anterolateral Chordotomy for Intractable Pain , J. A. M. A. 100:1925-1928 ( (June 17) ) 1933. 9. (b) Hyndman, O. R., and Van Epps, C.: Possibility of Differential Section of the Spinothalamic Tract: A Clinical and Histologic Study , Arch. Surg. 38:1036-1053 ( (June) ) 1939. 10. Davis, L.; Hart, J. T., and Crain, R. C.: The Pathway for Visceral Afferent Impulses Within the Spinal Cord: II. Experimental Dilatation of the Biliary Ducts , Surg., Gynec. & Obst. 48:647-651 ( (May) ) 1929.

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 1947

References