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Stay the Knife. Technically, the total suppression of pain comes only with anesthesia, which cannot be prolonged. The lighter state of analgesia, or relief of pain without loss of consciousness, is far more difficult to achieve. For cancer patients with intractable pain of indisputably physical origin, neurosurgeons have devised a number of radical operations. One of the commonest, for pain anywhere below the neck, is cordotomy—literally, cutting the spinal cord—a remedy that is less drastic than it sounds. In the standard operation, the cord is exposed and a small cut is made in the nerve bundles controlling the pain-afflicted area. The so-called cut may actually be a tiny electrical burn. Crue and his colleagues have just reported a refinement, in which small electrodes are implanted through the skin and left in place, so that the treatment can be repeated if pain recurs. Other neurosurgical procedures involve cutting the roots of nerves at the spine to relieve cancer pain in the lower end of the backbone, and cutting or chemically killing the trigeminal nerve in the face to halt the agonizing stabs of tic douloureux, the most agonizing form of neuralgia.
Many neurosurgeons would stay the knife if they could, and are joining with pharmacologists to develop better ways of relieving pain with drugs. As many as 65% of tic douloureux victims can be treated effectively, says Crue, with drugs originally designed to control epileptic seizures. For the relief of severe pain of virtually every kind, morphine and its synthetic analogues remain the most potent drugs known,* but all are highly addicting and need to be taken in stepped-up doses to maintain a constant level of analgesia. Supposedly nonaddicting substitutes are exultantly reported almost every year by research chemists, and are found just as regularly to be addicting in proportion to their effectiveness. Aspirin remains the most widely useful and, for most patients, the safest of analgesics, despite its limited potency.
The newest and most significant advances in relief and control of pain have come through the side door, from psychiatry. Three in number, they involve the use of psychotropic drugs, the application of standard psychotherapeutic techniques, and hypnosis. First of the drugs to find favor was chlorpromazine (Thorazine), used to reduce the severe anxiety of patients with advanced cancer. Serendipitously, it was found that when their anxiety was lessened, so was their perception of pain —though not necessarily the underlying sensation. Many a patient said: "Doctor, I still feel the pain, but it doesn't bother me so much."