Deep Brain Stimulation for Neuropathic Pain

Owen, Sarah; Green, Alexander L.; Nandi, Dipankar; Bittar, Richard G.; Wang, ShouYan; Aziz, Tipu Z.

doi:10.1111/j.1525-1403.2006.00049.x

Cited by 52 publications

(34 citation statements)

References 23 publications

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“…The stimulation of this structure may provide long-term effective pain relief in selected patients [52,53]. The PAG receives afferents from the central and from the peripheral nervous systems.…”

Section: Descending Pain Modulatory Systemmentioning

confidence: 99%

Nociception and autonomic nervous system

et al. 2013

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The International Association for the Study of Pain (IASP) defines pain as ''an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage''. Pain may also be experienced in absence of noxious stimuli and together with temperature and other bodily feelings constitute the interoception redefined as the sense of the physiological condition of the entire body, not just the viscera. The main characteristic of these feelings is the affective aspect. Emotion, motivation, and consequent behavior connected with these feelings characterize their homeostatic role. This implies an interaction between neural structures involved in pain sensation and autonomic control. The aim of this review is to focus on pain perception, mainly on pain matrix structures' connections with the autonomic nervous system.

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Section: Descending Pain Modulatory Systemmentioning

confidence: 99%

Nociception and autonomic nervous system

et al. 2013

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“…Other pain etiologies for which we and others have obtained good outcomes using DBS are stroke [48,79]; cephalalgia, including postherpetic trigeminal neuralgia and anesthesia dolorosa [47,80]; multiple sclerosis [43]; genital pain; and malignancy [73,81]. We find little merit in the administration of opiates or naloxone to determine suitability for DBS, although a historical literature exists [46].…”

Section: Patient Selectionmentioning

confidence: 98%

“…Our experience of DBS for pain after upper limb or brachial plexus injury [72,73] encourages us to consider DBS as a first-line treatment for complex regional pain syndromes. A recent paradigm shift towards central brain reorganization with autonomic dysfunction as the mechanism underlying complex regional pain syndromes support the treatment for brachial and lumbar plexus injuries, and stump pain after amputation, as well as phantom limb pain [74][75][76][77][78].…”

Section: Patient Selectionmentioning

confidence: 99%

Neuropathic Pain and Deep Brain Stimulation

Pereira

Aziz

2014

Neurotherapeutics

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Deep brain stimulation (DBS) is a neurosurgical intervention the efficacy, safety, and utility of which are established in the treatment of Parkinson's disease. For the treatment of chronic, neuropathic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated with current standards of neuroimaging and stimulator technology over the last decade . We summarize the history, science, selection, assessment, surgery, programming, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and latterly rostral anterior cingulate cortex (Cg24) in 113 patients treated at 2 centers (John Radcliffe, Oxford, UK, and Hospital de São João, Porto, Portugal) over 13 years. Several experienced centers continue DBS for chronic pain, with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS under general anesthesia considered for whole or hemibody pain, or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.

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“…Stimulation of the PVG and VC for central poststroke pain (CPSP), however, has failure rates ranging from 33% to 82%. 4,8,9 These poor results suggest that alternative targets should be explored.…”

Section: T He Efficacy Of Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

Mallory

Abulseoud

Hwang

et al. 2012

Mayo Clinic Proceedings

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Although deep brain stimulation (DBS) has been found to be efficacious for some chronic pain syndromes, its usefulness in patients with central poststroke pain (CPSP) has been disappointing. The most common DBS targets for pain are the periventricular gray region (PVG) and the ventralis caudalis of the thalamus. Despite the limited success of DBS for CPSP, few alternative targets have been explored. The nucleus accumbens (NAC), a limbic structure within the ventral striatum that is involved in reward and pain processing, has emerged as an effective target for psychiatric disease. There is also evidence that it may be an effective target for pain. We describe a 72-year-old woman with a large right hemisphere infarct who subsequently experienced refractory left hemibody pain. She underwent placement of 3 electrodes in the right PVG, ventralis caudalis of the thalamus, and NAC. Individual stimulation of the NAC and PVG provided substantial improvement in pain rating. The patient underwent implantation of permanent electrodes in both targets, and combined stimulation has provided sustained pain relief at nearly 1 year after the procedure. These results suggest that the NAC may be an effective DBS target for CPSP.

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Deep Brain Stimulation for Neuropathic Pain

Cited by 52 publications

References 23 publications

Nociception and autonomic nervous system

Nociception and autonomic nervous system

Neuropathic Pain and Deep Brain Stimulation

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

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