Trans-spinal Ganglionectomy for Relief of Intercostal Pain

NY approach to the surgical relief of pain must be oriented to the prob. lems of understanding pain itself, particularly in relation to its organic and psychological variables. Even from the organic standpoint, this understanding is difficult inasmuch as the role of the somatic and visceral systems in relaying stimuli is not clearly defined because of associated neuroanatomical and neurophysiological complexities. The purpose of this paper is to relate our experiences with surgical treatment of one type of pain problem, the burning segmental thoracic discomfort termed causalgia. The 10 cases described, except for one, have had pain following either thoracotomy or thoracic herpes zoster. The first such patient in our series was a 66-year-old woman referred to us after thoracotomy because of diffuse pain in the chest wall associated with extension of pulmonary cancer. We performed a high cervical cordotomy, which relieved the diffuse pain by producing loss of pain perception up to the acromial level. However, the patient soon began complaining of burning pain and hypersensitivity to light touch in the segment of the thoracotomy scar. We sought an approach for interrupting the pathways relaying this segmental causalgia, since it was not possible to perform a classical transthoracic approach for sympathectomy of the intercostal segments concerned with her pain because of the carcinoma invading the pleural surface of the chest wall.