Intrathecal phenol block in treatment of intractable pain of malignant disease.

9 / / I " o pain and drug depression. A more reasonable approach t o th~ problem is t endeavour to control the pain in a man~aer which will permit t~ese patients to enjoy the fullest possible life compatible with the disab.~lity imposed by the disease. This is a fertile field for cultivation by the anaesthetist. Pain associated with malignant disease may be produced by ~eyeral mechanisms. Direct infiltration of tissues by the tumour involves ~eriph~ral nerves, and produces local pain. Chronic inflammatory reaction about I an e~larging tumour may also be a causative factqr. A common cause of pain is rogt pressure produced by vertebral metastases. Spinal nerve roots and periphera I nerves may be directly infiltrated, and peripheral nerves may be involved in! the process of scarring following radiation therapy. These causes of pai~ are/such that relief by the destruction of individual peripheral nerves can seldomlbe satisfactory, and treatment can only be ,successful when directed to the nerge roots or the pathways for pain within the central nervous system. The ideal in treatment would be achieved ff it were possible ~to destroy those fibres serving pain sensation, and to leave intact all other ~ensoty fibres. This is the philosophy of the selective tractotomy which th~ neurosur~eon endeavours to obtain in such cases, and of thalamotomy. To the pre~ent ~me we have no chemical substance which can be guaranteed to produce this situation, although experi~ence .suggests that phenol in certain concentration~ and I applied by the techniques which we shall describe may at times produce this ideal situation. The use of the injection of neurolytic agents to obliterate]intractable pain was first suggested by Dogliotti in 1931, when he advocated thq use of absolute 9 ] " 1 alcohol for this purpose, While this technique has been yade ) u s e d a n d with varying success, the use* of alcohol destroys all sensation iti the ,egments treated and by irritation of neighbouring roots may i~roduce severe p~ neuritis. In 1955 Maher 1 reported the successful use of solutions o I into the spinal fluid for the relief of 13ain in rmtients suffering and described this technique as sp~ing other sensation and m ,in from alcohol ?phenol injected from carcinoma, otor Junction in