Treatment of pain of carcinoma of the tongue and floor of the mouth

Fifty-two patients with uncontrolled pain due to carcinoma of the tongue and floor of the mouth were treated by the author as a member of a pain clinic.

The pain involved in part or in whole the sensory distribution of the trigeminal, facial, glossopharyngeal and vagus nerves and the superficial branches of the cervical plexus.

Treatment required attention to the general care of the patient through psychotherapy, reassurance, nutrition, etc.; the use of analgesics, antidepressants and sedatives; and sensory denervation of the affected areas.

Sensory denervation was achieved by chemical neurolysis with absolute alcohol in preference to direct surgical attack. The methods used follow the standard nerve block procedures with Bonica's technique for intrathecal alcohol preferred for the cervical plexus.

Eighty per cent of these patients received significant pain relief from this approach. Those who were unrelieved were managed by increasing doses of narcotic analgesics until their death.

The value of a pain clinic in the assessment and management of this form of intractable pain and the importance of the anaesthetist's role is emphasized.