The role of rostral cingulumotomy in "pain" relief
Foltz, E.L.; White, L.E.
International Journal of Neurology 6(3-4): 353-373
1968
ISSN/ISBN: 0020-7446 PMID: 5759640 Document Number: 5896
1) Rostral cingulumotomy as demonstrated in a series of 35 patients has a role in the treatment of patients who have incapacitating pain and who demonstrate associated emotional factors. Three groups of patients were included: 1) 9 patients with "psychogenic pain"; 2) 15 patients with organic pain syndromes associated with strong emotional factor; and 3) 11 patients with neoplastic disease in whom pain and emotion were intertwined. The procedure is likewise effective in attenuating addictionwithdrawal syndrome in patients addicted because of pain problems. 2) The "personality change" induced by rostral cingulumotomy under conditions of proper patient selection is related to a reduction in emotional reactivity and is considered to be advantageous. Complications of the operative procedure are not significant. The reliability of patient selection on the basis of psychiatric evaluation is not clear, but patients with neo-operative anxiety and depression showed the best clinical results. 3) On the basis of ancillary clinical phenomena introduced by cingulumotomy in patients with normal brains and in patients with diseased brains or nervous systems, the favourable effect of cingulumotomy appears to be due to a volume-reduction effect on augmented, unstable homeostatic mechanisms. 4) A concept of the anatomic-physiologicclinical function of the limbic lobe is presented, based on correlation of this study with already known anatomic and physiologic facts concerning the limbic lobe. The "outer limbic ring", which includes the highly important cingulum, is influenced by both the "extralimbic cortex" (which related to external environment, is future-oriented) and the "inner limbic ring" (which is phylogenetically primitive, functions to achieve protective action via brain stem effector systems). Homeostasis is achieved by the limbic lobe through the interaction of these three parts. In patients with pain problems. as presented, it is the abnormal, unstable augmentation of the homeostatic functions which is critically modified by cingulumotomy by a volume-reduction effect to thereby re-establish a balance of sorts in this system. The resulting lower gain system produces favorable clinical changes.
Document emailed within 1 workday
