PRESENT STATUS OF PERIPHERAL NEURECTOMY FOR PAIN IN OBLITERATIVE ARTERIAL DISEASE *

It is not generally known that section of peripheral nerves is available as-a therapeutic measure in a number of patients suffering from intractable pain resulting from obliterative disease of the arteries. The term “peripheral neurectomy” usually is connected with the therapy of intractable pain associated with the supra-orbital, glossopharyngeal, greater and lesser occipitals and other nerves in the head. The purpose of this communication is to point out that in the treatment of occlusive arterial disease of the extremities, particularly the lower extremities, peripheral neurectomy occupies a significant, although limited place, when intractable pain occurs. Recourse to the surgical literature or to textbooks of surgery will be of little aid to the physician who desires to learn the uses and limitations of this surgical measure, because so little has been written about it. By “intractable” pain is meant the severe rest) pain which is frequently seen in cases of arteriosclerosis obliterans and thromboangiitis obliterans, particularly when there is localized ulceration or gangrene of the toes or distal portions of the foot. In patients having thromboangiitis obliterans, the blood supply to the remainder of the limb may well be adequate; but in patients with arteriosclerosis obliterans, intractable pain is often indicative of complete arterial insufficiency. In either case, there are far more limbs lost each year by amputation than need be. Frequently, concentrated efforts with conservative measures can salvage limbs which would otherwise be lost. These measures include cessation of smoking, reflex vasodilatation, vasodilator drugs, Buerger-Allen exercises, antibiotics when indicated, control of organic diseases such as diabetes mellitus, and therapy for functional diseases when present, together with the increasing use of lumbar sympathectomy (1) and, in some cases, peripheral neurectomy (2, 3, 4).