Bilateral anterior cingulotomy for chronic noncancer pain

OBJECTIVE: To document the value of bilateral anterior cingulotomy for pati ents with intractable chronic noncancer pain. METHODS: Twenty-three patients who underwent 28 cingulotomies between 1979 and 1996 for chronic refractory pain were sent questionnaires regarding the ir subjective response to the surgery and its impact on their pain. Questio ns dealt with pre- and postoperative pain, ability to resume work or usual activity, medications, family and social interactions, and overall benefit of cingulotomy. Results were compared with long-term (average, 8 yr) clinic al follow-up. In 13 patients, pain was predominantly caused by lumbar adhes ive arachnoiditis or "failed back." The remainder had venous occlusive dise ase, ischemic bilateral leg pain, phantom leg pain, postoperative neck pain , or atypical facial pain. RESULTS: Eighteen patients returned questionnaires; two patients died of un related causes. Seventy-two percent of patients reported improvement in the ir pain, 55% were no longer taking narcotics, 67% noted improvement in thei r family life, and 72% noted improvement in their social interactions. Fift y-six percent of patients reported that the cingulotomy was beneficial, and 28% returned to their usual activities or work. Thirty-nine percent of pat ients developed transient or well-controlled seizures. Five patients requir ed a second cingulotomy, and one patient did well despite developing brain abscesses. Patient assessments corresponded closely with clinical assessmen ts. CONCLUSION: Bilateral anterior cingulotomy is safe for patients with refrac tory chronic pain. Seizures reported in this series were well controlled wi th medication. More than half of all respondents thought they had a positiv e outcome and that cingulotomy was beneficial to them. There were no deaths related to the procedure.