Subarachnoid Injection O F Alcohol for Relief O F Intractable Pain with Discussion of Cord Changes Found at Autopsy

Subarachnoid injection of alcohol for the relief of intractable pain was introduced by Dogliotti (1, 2 ) before the .Academy of Medicine of Turin in December 1930. He was induced to try it in the belief that to suppress pain surgically it was not necessary to destroy all the sensory fibers but to reduce the number and intensity of stimuli sufficiently so that they would not register as pain. The assumption was that peripheral fibers specific for pain do not exist but that excessive stimuli of sensory nerve fibers are registered as pain. Dogliotti visited this country and demonstrated his technic, following which time a number of reports concerning the method, its indications and results, have appeared in the American literature (3-14). The technic is so ably described in several of these publications (3, 6, 11) that it is not necessary to repeat it here. The purpose of this report is to give the results obtained and complications encountered in 33 cases of inoperable cancer of hopeless prognosis, and to record the changes found in the spinal cord and nerve roots in 4 cases after subarachnoid alcohol injections. Histological studies of the spinal cord following spinal anesthesia both in experimental animals and in human material obtained at autopsy have been reported (15-18). Changes do occur according to these investigators, but as a rule disappear within ninety days or less. The cord examined by Brock et al, however, still showed myelopathy three months after the injection of nupercaine. Observations of cord changes following the subarachnoid injection of alcohol for relief of pain, according to the technic of Dogliotti, have apparently not been p ~ b l i s h e d . ~ Findings following the injection of alcohol into the lumbar subarachnoid space in cats were reported by Aird and Naffziger (19). Their results are discussed below. In this clinic 33 patients, all of whom were believed to have incurable malignant tumors, have received subarachnoid injections of alcohol. The spinal cords of 4 patients who lived from three to six months after injection were studied at autopsy. A series of experimental injections in 5 dogs was also made, but the results were not satisfactory. I t was difficult or impossible to obtain even approximately the same conditions as obtained in man and impossible to determine whether or not a satisfactory injection was accomplished, that is one that would relieve pain if it were present. Many of the dogs developed paralysis and gross degenerations were found in the cord