Bilateral Open Thoracic Cordotomy for Refractory Cancer Pain: A Neglected Technique?

Abstract At least 10% of patients with cancer have pain that is refractory to systemic analgesics. For most of these patients, interventional techniques may be of benefit but are often not considered or are difficult to access. Of these techniques, spinal analgesia is most commonly used in Australia...

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Bibliographic Details
Published in:Journal of pain and symptom management 2010-05, Vol.39 (5), p.924-929
Main Authors: Atkin, Nicola, MBBS, MA, MRCP, Jackson, Kate A., MBBS, DTM&H, FRCA, FAChPM (RACP), FFPMANZCA, Danks, R. Andrew, MBBS, MD, FRACS
Format: Article
Language:English
Subjects:
Anesthesia & Perioperative Care
bilateral cordotomy
Biological and medical sciences
Cordotomy
Humans
Male
Medical sciences
Neurofibroma, Plexiform - complications
Neurofibroma, Plexiform - surgery
open cordotomy
Pain Medicine
Pain, Intractable - complications
Pain, Intractable - surgery
Pharmacology. Drug treatments
Refractory cancer pain
Spinal Cord Neoplasms - complications
Spinal Cord Neoplasms - surgery
spinothalamic tractotomy
Thoracic Vertebrae - surgery
Treatment Outcome
Young Adult
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Summary:Abstract At least 10% of patients with cancer have pain that is refractory to systemic analgesics. For most of these patients, interventional techniques may be of benefit but are often not considered or are difficult to access. Of these techniques, spinal analgesia is most commonly used in Australia and the United Kingdom, and neurosurgical procedures, such as open cordotomy with sectioning of the spinothalamic tract, are rarely used. We describe a case illustrating the successful use of bilateral open thoracic cordotomy in a patient with refractory mixed nociceptive and neuropathic pain secondary to a lumbosacral tumor. We discuss the various interventional options and review the recent literature regarding the use of both percutaneous and open cordotomy for cancer pain.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2009.09.011