Frontal lobotomy for the relief of intractable pain


By R Carter

As I go through PubMed looking for articles on the treatment of chronic pain or addiction I come across a fair number of ideas that in my opinion are just way out there. But I tend not to be critical because science is a search for truth and answers, even if some of the ideas are Frankensteinish.

Today a reference popped up advocating a frontal lobotomy as a treatment for intractable chronic pain. The idea of this as a treatment made me shutter at the idea.

I saw the date of original publication which was 1950 and had a sigh of relief until I saw the number of current references to this publication and realized it was still be reviewed as a possible treatment for some types of chronic pain. I cringed again as I realized some researchers were taking this seriously. I had no idea such draconian methods were still being investigated. But in this age of opiate hysteria and extremism, I’m no longer surprised by irrational leaps of logic which strain at statistically insignificant data points in their effort to justify their bias and prejudice. What is most amazing now is the number of high profile medical professionals who publicly come out supporting such ideas knowing that their equally qualified peers know the difference between BS and real medicine. How embarrassing it must be, but being a social outcast for taking such a position must pale in comparison to the $$ benefit which comes from selling out your peers and the public.

Current trends in forced tapering or sudden termination of pain medication for patients who have been on it for years, in my opinion, is not that different. When the primary goal of such treatment is to prevent addiction, aren’t such methods as draconian as a frontal lobotomy? The same people who advocate for these extremes are also advocating for separate drinking fountains, bathrooms and seating areas for blacks and whites. It’s a resurgence in conservative white privilege we haven’t seen in more than forty years and that should frighten everyone.

A comparable example would be tapering or terminating the use of insulin in a diabetic, forcing them to use diet alone to manage their blood sugar. How about denying someone medication for high blood pressure, forcing them to use diet and exercise because we believe that is better for them. Or denying a long time smoker with COPD an inhaler because they made a socially unacceptable choice to use tobacco products? 

When such thinking manifest itself as a seven day limit on opiates for surgical procedures such as a thoracotomy or a hip replacement, haven’t we thrown the baby out with the bathwater?

These examples are not small operations, each requires 8-10 weeks to fully recover. The first 6 of which are traditionally treated with opiates and have been long before there were any concerns about opiate abuse.

Consider a patient with 2nd and 3rd degree burns over 50% of their body, who spends 12 weeks in the hospital recovering. Such a patient can’t be discharged to home with 7 days of pain medication, so do you keep them in the hospital?

So what’s changed in the last 10 years, is it our physiology, our ideology, our morality or just our rationality?

Offbeat ideas such as this are offered up by anti-opiate zealots, who propose extreme measures in prescribing opiates. Those who verbalize them, who turn them into laws and regulations want the rest of us to believe that these are rational concepts.

And why, because at any given moment, less than 1% of our population is currently abusing opiates. Only 10% of the population will abuse them at one point during their 70 year lifetime, but to listen to the radicals, this represents a crisis, an epidemic so extreme that everyone should be limited.

Yet for all the fear and blame they toss around, they ignore facts such as 66% of the population abuses alcohol and nearly every opiate overdose death includes alcohol. But no one is suggesting we place limits on alcohol. In medicine, alcohol has limited benefits.

In the 1950’s it was used during premature labor to stop contractions preventing premature birth. It’s used as a tincture or solvent in some medication preparations and it was used in anesthesia because it’s a neurotoxin, to oblate nerves and stop intractable pain in localized areas. 

So alcohol has no redeeming value except as a social lubricant to facilitate interpersonal interactions. Yet it’s a far greater contributor to OD deaths than opiates, appearing with Heroin and Cocaine overdoses routinely. But limiting this substance is unlikely because it would impinge upon the rights of those trying to limit opiates for the rest of us. Let’s call that what it is, Hypocrisy!

You won’t hear about the 1% but you will hear about the 10% and it will be misrepresented because this is how you promote yourself, by pointing out the faults of others and why you should be afraid of them.

In 1943 after the bombing of Perl Harbor, Japanese citizens in Hawaii and the continental U.S. were placed in internment camps for no other reason than, they were Japanese. Jap hysteria was on the minds of middle-class America and out of fear, poisoned by bias, many U.S. citizens were imprisoned because they were different, they were not white native-born citizens. As if this was a requirement to believe in and live by our Constitution.

America has a long history of racists bigotry and for all the rhetoric about the land of the free and the home of the brave, American’s continue to prove otherwise when fear clutches their souls.

We’ve become a country of anger and hate so obsessed with winning at any cost, we can no longer count the cost of winning because we’re too busy climbing over the bodies in our rush to prepare for the next battle.

After WW2 winning was defined as all of us have a better life, free of fascism, hate and tyranny. Somehow we’ve lost sight of that. Today winning is a singular endeavor, measured only by our individual success without regard for those less fortunate than us. We demand the rights and freedoms to better ourselves then deny those same rights to others for no other reason than, in our minds, they’re different than us. They’re too conservative, too liberal, the wrong color, the wrong race, or simply because they were not born here and they have an accent.

And with no regard for a moral power greater than ourselves, we believe we are answerable to no one but ourselves and this justifies our continued prejudice and bias.

In America, we used to say that it’s our diversity which made us great. Today we say the same, but secretly we plan how to give ourselves more choices and greater rewards, while we legislate laws that deny others the same and if that fails, we simply buy their silence after breaking rules we expect others to live by.

Freedom of speech is no longer thr freedom to voice your views, debate the merits of an issue then cast your vote. No, it’s become freedom to bash and bludgeon your opponent with their faults and shortcomings, a license to lie, telling others what they should be afraid of and who’s to blame. And why, so we can profit from it, either monetarily or by securing our safety and maintaining our position in society.

This way of thinking couldn’t be more evident than it is now as we listen to the debate around how to manage physical pain and the use of opiates. It’s a microcosm that reflects our true nature, our real selves. The actions we take as a society, whether we choose to let legislators play doctor, whether we deny medication for those who are no threat to others, will determine how deep this sickness in our soul runs.

And if we fail, the generation behind us will learn from our failures, repeating them with greater impetus and malice than we ever would, until this nation implodes under the weight of it. What today is only bitter backbiting, may in thirty years be class-based anarchy fought on the streets of our communities.