Background: Stereotactic anterior cingulotomy has been used in the treatment of patients suffering from refractory oncological pain due to its effects on pain perception. However, the optimal targets as well as suitable candidates and outcome measures have not been well defined. We report our initial experience in the ablation of 2 cingulotomy targets on each side and the use of the Brief Pain Inventory (BPI) as a perioperative assessment tool. Methods: A retrospective review of all patients who underwent stereotactic anterior cingulotomy in our Department between November 2015 and February 2017 was performed. All patients had advanced metastatic cancer with limited prognosis and suffered from intractable oncological pain. Results: Thirteen patients (10 women and 3 men) underwent 14 cingulotomy procedures. Their mean age was 54 ± 14 years. All patients reported substantial pain relief immediately after the operation. Out of the 6 preoperatively bedridden patients, 3 started ambulating shortly after. At the 1-month follow-up, the mean preoperative Visual Analogue Scale score decreased from 9 ± 0.9 to 4 ± 2.7 (p = 0.003). Mean BPI pain severity and interference scores decreased from levels of 29 ± 4 and 55 ± 12 to 16 ± 12 (p = 0.028) and 37 ± 15 (p = 0.043), respectively. During the 1- and 3-month follow-up visits, 9/11 patients (82%) and 5/7 patients (71%) available for follow-up reported substantial pain relief. No patient reported worsening of pain during the study period. Neuropsychological analyses of 6 patients showed stable cognitive functions with a mild nonsignificant decline in focused attention and executive functions. Adverse events included transient confusion or mild apathy in 5 patients (38%) lasting 1-4 weeks. Conclusions: Our initial experience indicates that double stereotactic cingulotomy is safe and effective in alleviating refractory oncological pain.
Following the widespread vaccination program for COVID-19 carried out in Israel, a survey was conducted to preliminarily assess behavior changes in the vaccinated population, prior to the expected upcoming policy change as to mask wearing and social distancing regulation in Israel. 200 people answered at least one question pertaining to preventive behaviour. Among the respondents, 21.1% reported a decrease in mask wearing compared to 47.3% who reported a decrease in social distancing. There was no difference in these measures between the sexes. However, people under the age of 50 were more likely to decrease mask wearing (28.1%) and decrease social distancing (56.1%), as compared with people over the age of 50 (17.2% and 41.8%, respectively). Among health care workers, there was a minimal decrease in mask wearing (1/23 people) compared to a more widespread decrease in social distancing (10/23). These data suggest that preventive attitudes change following COVID-19 vaccination, with less adherence to social distancing as compared to mask wearing, and should be taken into account when planning public policy in the future.
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