Thorax 1999;54:238-241 ( March )

Percutaneous cervical cordotomy for the control of pain in patients with pleural mesothelioma

M B Jackson,^a D Pounder,^b C Price,^b A W Matthews,^a E Neville^a

^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

BACKGROUNDSevere 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.

Keywords: cordotomy; pleural mesothelioma; pain control

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© 1999 by Thorax
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