A particularly interesting application of the method described above is in the treatment of pain related to traumatic lesions. The study of wounds from the standpoint of the offbalance present has revealed a definite pattern in their evolution. In all wounds, there is an initial period during which the offbalance is always type D, corresponding to a predominance of fatty acids. This can be recognized indirectly by measuring the local pH which shows alkalosis, the chloride content which shows a manifest increase, and by cytological and histological studies which indicate a rapid cellular aging process, with necrosis and sloughing. In uncomplicated wounds, in humans, the painful period usually lasts a few days. The pain in this initial period is of an alkaline pattern.

The constancy of the alkaline pattern in pain in traumatic lesions eliminates need for any tests, thus simplifying therapeutic choice by reducing agents to be used to one group—those with positive character.

As already noted, some of the agents are more effective than others in influencing alkaline pain. Butanol and heptanol are particularly useful in traumatic pain, followed in order of activity by polyunsaturated alcohols, nikethamide and glycerol.

One important application of these findings is in routine treatment of postoperative pain. For surgical wounds, which represent typical traumatic lesions, butanol appears to be especially beneficial. Its use has been the subject of extensive studies by B. Welt (187) in surgery in otorhinolaryngology, (Note 2) (Fig. 144) by M. Welt in ophthalmology (188), by A. Ravich in urology (189) (Note 3), and by S. Sheer in plastic surgery. (190).

Fig. 144. Results obtained with butanol in postoperative pain—compared with subjects receiving saline as placebo—(From B. Welt—AMA Archives of Otolaryngology. 52. 540. 1950.).

Results obtained with butanol in postoperative pain—compared with subjectsResults 12 hours after the butanol injections

Fig. 145. Results 12 hours after the butanol injections. (From B. Welt, AMA Archives of Otolaryngology, 50, 590, 1950.).

With more than 10,000 cases treated, butanol seems to be completely safe as well as highly effective. Not a single case of undesirable reaction due to the medication has been noted. The dose necessary to obtain pain relief varies with the amount of traumatized tissue. With an adequate dose of butanol, the patient has a minimum of pain, is conscious, and without impairment of intestinal and bladder function. Butanol also has a marked preventive action against hemorrhage, which will be discussed below.

Success with this medication depends upon adequate dosage. The addition of butanol to the saline solutions customarily used in postoperative care has done much to simplify the problem of administering it in adequate doses without resorting to supplementary injections. Doses as high as 100 cc. or even 200 cc. of 6.5% solution of butanol have been administered in the first days following surgery, with good results and no inconvenience to the patient.

Administered by injection or orally in only very small doses, heptanol is helpful. A mixture of heptanol, butanol and polyunsaturated alcohols constitutes a valuable preparation for controlling postoperative pain. Butanol, heptanol and glycerophosphoric acid added to glucose and saline has proved very helpful to control not only pain but also the other disagreeable post operative manifestations. (Note 4)

In other forms of trauma, such as accidental wounds or fractures, the same agents have been equally successful if in sufficient doses.

With their use, the healing period seemed to be shortened, as shown in experiments in rats and rabbits. In animals with standardized wounds, the healing of connective tissue in particular is accelerated. In wounds treated with preparations of cholesterol, sterols or insaponifiable fractions of organs, the healed epithelium shows abnormally high proliferation.