Nauta et al. reported on a successful punctate midline myelotomy (PMM) for
the treatment of intractable pelvic pain. The authors describe an other cas
e history of a patient with multiple anaplastic carcinomas of the small int
estine, peritoneal carcinosis and retroperitoneal lymphomas, suffering from
severe visceral pain in the hypo-, meso-, and epigastrium. Nauta's PMM was
successfully performed at the Th4 level. Narcotic medication was tapered f
rom 30 mg iv, morphine per hour pre-operatively to 5 mg per hour within 5 d
ays postoperatively. Intensity of pain decreased from 10 to 2-3 on the visu
al analog scale. Only minor transient side effects appeared and the patient
was discharged 5 days postoperatively. The pain reduction was maintained u
ntil the patient died from the extended disease five weeks later.
We conclude that punctate midline myelotomy sufficiently controls not only
pelvic visceral pain, but also visceral pain generated in the meso- and epi
gastrium. The findings support the concept of a midline dorsal column visce
ral pain pathway.