Transorbital lobotomy in the relief of intractable pain.

Abstract

FREEMAN and Watts1give the detailed history of a patient with conversion hysteria on whom prefrontal lobotomy was carried out in 1936. At the time, the authors' attention was focused on the complex neurosis. They were agreeably surprised, however, to discover that with remission of the psychoneurotic symptoms a concomitant relief of disabling pain occurred. It is probable that this case represents the first attack on the frontal lobes as a method of relieving intractable pain. In June 1946 Freeman and Watts2reported five cases of organic disease in which relief of pain was accomplished by means of prefrontal lobotomy. This group included carcinomatosis, tabes dorsalis, the thalamic syndrome, trauma to the cauda equina and hysterical contractures. They commented that apparently Van Wagenen was the only neurosurgeon at that time employing this method for the relief of intractable pain. Since then the procedure has gained rather wide acceptance