The punctate midline myelotomy concept for visceral cancer pain control--case report and review of the literature

Abstract

Introduction: Nauta et al. first reported on a successful punctate midline myelotomy (PMM) at the spinal cord Th 10 level for the treatment of intractable pelvic cancer pain.

Case study: The authors published another case history of a patient with multiple anaplastic carcinomas of the small intestine, peritoneal carcinosis and retroperitoneal lymphomas, suffering from severe visceral pain in the hypo-, meso-, and epigastrium. Nauta's PMM was successfully performed at the level Th 4. Narcotic medication was tapered from 30 mg i.v. morphine per hour preoperatively to 5 mg per hour within 5 days postoperatively. Pain intensity decreased from 10 to 2-3 on the visual analog scale. Only minor transient side effects appeared postoperatively. Pain reduction remained until the patient died from the extended disease five weeks later.

Discussion: Meanwhile Nauta et al. reported on 5 additional patients, in whom PMM led to a sufficient pain reduction. Another paper reported on sufficient control of visceral pain due to advanced stomach cancer after a modified Th 1-2 PMM.

Conclusion: PMM sufficiently controls not only pelvic visceral pain, but also visceral pain generated in the meso- and epigastrium. The findings support the concept of a midline dorsal column visceral pain pathway.