Prefrontal Lobotomy for the Relief of Intractable Pain; Value and Limitations

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THE relief of pain has been one of the chief concerns of physicians since time immemorial. Medical history reveals the use of a wide variety of mechanical procedures, administration of substances such as herbs and drugs, as well as the employment of incantations and witchcraft to relieve discomfort. Fortunately, through the “growth process” of medicine, scientifically sound medications and surgical procedures have been developed to achieve the relief of pain. In the majority of painful conditions mitigation is achieved by the present day routine surgical and medical armamentarium. However, in certain cases of advanced diseases, as well as in some of the more severe disorders of the nervous and emotional systems, the usual measures of pain alleviation are inadequate.

Surgical methods, both conservative and radical, have been employed for the relief of pain with varying degrees of success. Within the past several years psychosurgery, originated in the modern sense by Moniz and Lima1 in 1935 and pioneered in America by Freeman and Watts,2 have afforded the neurosurgeon a new and more potent weapon to be used in cases where intractable pain, extreme anxiety and depression and accompanying drug dependence have become issues of paramount importance.

Numerous articles on prefrontal lobotomy have appeared in the medical literature. This discussion will not attempt to evaluate the procedure. The following case reports merely demonstrate that prefrontal lobotomy serves a useful purpose in the present day therapy.

Case Reports

Case 1. Intractable Pain from Carcinoma of the Mastoid

A 58-year-old white woman came to. . .



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