Pain “Relief” by Frontal Cingulumotomy. Foltz & White, L. E. (1962).

Woolie

Woolie

Senior Member
Just came across this and had to share this with you all. Very old, but still, my eyes popped at the patient descriptions. Not to mention the "treatment".

Sort of in the category of "things could be worse"....

Its a description of the outcomes of several patients with "psychogenic pain" or organic pain "with a strong emotional or psychogenic component" who were treated with neurosurgery (a portion of their cingulum, a bundle of white matter fibres, was removed on one or both sides).
Case I-1. M.W., 68-year-old white female, had been suffering from intense burning vaginal and perineal pain for over 2 years. Thorough repeated examinations by the gynecologists, general surgeons, and internists had failed to reveal significant primary organic disease. She had been completely bedridden in the hospital for over 9 months, had received two series of electroshock therapy and severe flexion contractions of the lower extremities had developed because of her refusal to get out of bed or move her lower extremities. The Department of Psychiatry felt she had "severe depression with maximum anxiety." The Department of Neurosurgery decided on cingulumotomy because of the complaint of severe, incapacitating pain associated with complex emotional factors.

After cingulumotomy, the change was indeed striking. She ceased her continual whining complaints, began to take note of her external environment, and began to move about again. Within 2 weeks, she was up and walking for the first time in 9 months. Shortly, she was able to leave the hospital, returned home, and resumed her housework activities. On questioning her, the pain was still present but did not concern her now. Over a 4.5 year follow-up, her complaints of pain have not returned to clinical significance.
Click to expand...

Case II-1. B.S., a 28-year-old white male, suffered a gunshot wound of the left brachial artery. His left arm steadily had become more painful with causalgic type of burning dysesthesia, which was precipitated frequently by emotional instability as well as sensory stimulation to the extremity. The Department of Psychiatry had stated his basic personality was such that he required this pain as a "somatic crutch," and that interruption of such support probably would cause a complete disruption of personality... Cingulumotomy was warranted because of the obvious anxious depression and striking emotional precipitation of his causalgic attacks. Following bilateral cingulumotomy, there was immediate complete cessation of emotional precipitation of his causalgic syndrome and, though he had a mild syndrome of withdrawal of narcotic, he rapidly became completely rehabilitated. He returned to his job as a draftsman, and apparently has maintained his compensated and stabilized personality for 6 years.
Click to expand...
The only bright spot in all this - if you could call it that - is the lack of overt sexism.The male case above seems to have been treated with as much dripping contempt as the female one.
 
strategist said:
Had she continued to complain about pain, they would have cut out more of her brain. No wonder she was miraculously cured.
Click to expand...
Yea. It also helped that the authors of the paper were also the surgeons.

I love how the guy was expected to have a total personality meltdown if he became separated from his pain - but miraculously, no meltdown happened! His "compensated personality" worked just fine!
 
Really sounds like they tortured her until she took the strategy of lying to get out of more torture. Or maybe they destroyed her brain so much it just removed the worst of the sensation. Cingulumotomy is a type of lobotomy.

I am continually amazed at how absurd this entire field of medicine is. You can't even parody it, it's so far beyond it. Barbaric with zero accountability.
 
rvallee said:
Really sounds like they tortured her until she took the strategy of lying to get out of more torture. Or maybe they destroyed her brain so much it just removed the worst of the sensation. Cingulumotomy is a type of lobotomy.
Click to expand...
Sort of, it still involves the frontal lobes, but the tissue removed is different. The cingulum is a bundle of fibres that communicates between the anterior cingulate (involved in motivated, goal-directed action), and regions of the brain involved in memory and emotion. Cingulumotomy effectively disables input from the anterior cingulate.

The effect is basically a de-motivating one. Its been proposed recently that the experience of pain reflects activity in a network, one component (the insula) is involved in evaluating incoming bodily signals, and another (the anterior cingulate) is involved in evaluating how aversive they are and allocating effort to tackling them - which can include taking direct action or modifying the autonomic system response.

It has been suggested that when the anterior cingulate is disabled, the person experiences only the incoming signals, and less of the aversiveneess, because that part of the pain experience requires the anterior cingulate.

But these guys wouldn't have known any of this back then, they were just flying by the seat of their pants.
 
You must log in or register to reply here.
Back
Top Bottom