CONTROL OF INTRACTABLE PAIN IN ADVANCED CANCER BY SUBARACHNOID ALCOHOL BLOCK

Relief from otherwise intractable pain in the lower portions of the body can frequently be afforded by the subarachnoid injection of absolute alcohol. The technique here described is believed to give more predictable results and to cause less of the distressing complications (paralyses, paresthesias, and vesical and intestinal dysfunction) than do older methods. This method, involving the careful positioning of the patient and other precautions to limit the action of the alcohol to the dorsal nerve roots, was applied in 106 patients with hopeless malignant disease. The results were classed as good in 53 and fair in 35. Ten spinal cords were examined at subsequent autopsies, and the most constant finding was demyelinization of the dorsal roots of the spinal nerves. The effects extended peripherally to the dorsal root ganglia and centrally into certain tracts within the cord. The abolition of pain was not always permanent, especially since metastases sometimes appeared in distant parts, but some patients were completely relieved for eight months or more.