PAIN MECHANISMS AND THE FRONTAL LOBES: A STUDY OF PREFRONTAL LOBOTOMY FOR INTRACTABLE PAIN

Abstract

Severing the connections of the prefrontal areas with the thalamus results in a profound alteration of the attitude of the patient toward his distress. He is able to feel pain and to react appropriately to it but he is no longer harassed by the anticipation of pain. Lobotomy has been employed in advanced carcinoma, in tabes dorsalis, in causalgia, in thalamic syndrome, and in other intensely painful conditions with abolition of distress. The frontal lobes are concerned with insight, and when their action is reduced the patient no longer experiences the same preoccupation with himself. In many instances, the pain seems to disappear, although the cause for this is not yet understood.