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a Department of
Respiratory Medicine, b Department of Pain Control, c Portsmouth Hospitals NHS
Trust, Portsmouth, UK
Correspondence to: Dr M B Jackson, Department of Respiratory Medicine, Southampton General Hospital, Southampton SO16 6YD, UK.
Received 16 June 1998; Returned to authors 17 August 1998; Revised version received 26 October 1998; Accepted for publication 17 November 1998
BACKGROUND
Severe
chest pain is common in mesothelioma. Percutaneous cervical cordotomy,
which interrupts the spinothalamic tract at the C1/C2 level causing
contralateral loss of pain sensation, is particularly appropriate in
mesothelioma as the tumour is unilateral and systemic analgesia may be
ineffective and is limited by harmful side effects.
METHODA retrospective
review was performed to determine the effectiveness and complication
rate of this procedure.
RESULTSFifty two
patients were using opioids prior to cordotomy. The median daily dose
of morphine before and after cordotomy was 100 mg (range 0-1000 mg)
and 20 mg (range 0-520 mg), respectively (p<0.001). Forty three
patients (83%) had a reduction in pain such that their dose of opioid
could be at least halved. Twenty patients (38%) were able to stop
completely. Recurrence of pain requiring an increase in opioid
medication was recorded in 18 patients at a median time of nine weeks
(range 0.7-26 weeks). Four patients developed mild weakness, two had
troublesome dysaesthesia. The median time from cordotomy to death was
13 weeks (range 0.3-52 weeks). Six early deaths within two weeks of
cordotomy occurred early in the series and reflect postoperative chest
infection and poor selection as the patients were in the terminal
stages of mesothelioma.
CONCLUSIONSPercutaneous
cervical cordotomy is successful in treating pain from mesothelioma.
There was a low complication rate in this series. Referral to a unit
experienced in cordotomy is recommended as soon as pain from chest wall
invasion is suspected.
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