Deep Brain Stimulation for Neuropathic Pain

Tasker, Ronald R.; Filho, Osvaldo Vilela

doi:10.1159/000098682

Cited by 59 publications

(38 citation statements)

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“…In the following decades, electrical stimulation of the thalamus, internal capsule, and periaqueductal gray matter or periventricular gray matter (PVG) became commonly used procedures to treat chronic refractory pain. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Within the last decade, the number of patients with chronic pain treated with DBS, as well as the number of the published studies, have progressively decreased, mainly because of the lack of solid scientific evidence of DBS safety and efficacy and the development of less invasive alternatives to manage nociceptive pain. Although DBS produced impressive results in a subset of patients, the results were highly variable, and appropriate patient selection seems to be very important.…”

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confidence: 99%

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Nardone

Höller

Leis

et al. 2013

The Journal of Spinal Cord Medicine

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Context: Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain.Objective: To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy. Methods: A MEDLINE search was performed using following terms: "Spinal cord injury", "Neuropathic pain", "Brain stimulation", "Deep brain stimulation" (DBS), "Motor cortex stimulation" (MCS), "Transcranial magnetic stimulation" (TMS), "Transcranial direct current stimulation" (tDCS), "Cranial electrotherapy stimulation" (CES). Results: Invasive neurostimulation therapies, in particular DBS and epidural MCS, have shown promise as treatments for neuropathic and phantom limb pain. However, the long-term efficacy of DBS is low, while MCS has a relatively higher potential with lesser complications that DBS. Among the non-invasive techniques, there is accumulating evidence that repetitive TMS can produce analgesic effects in healthy subjects undergoing laboratory-induced pain and in chronic pain conditions of various etiologies, at least partially and transiently. Another very safe technique of non-invasive brain stimulation -tDCS -applied over the sensorymotor cortex has been reported to decrease pain sensation and increase pain threshold in healthy subjects. CES has also proved to be effective in managing some types of pain, including neuropathic pain in subjects with SCI. Conclusion: A number of studies have begun to use non-invasive neuromodulatory techniques therapeutically to relieve neuropathic pain and phantom phenomena in patients with SCI. However, further studies are warranted to corroborate the early findings and confirm different targets and stimulation paradigms. The utility of these protocols in combination with pharmacological approaches should also be explored.

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mentioning

confidence: 99%

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Nardone

Höller

Leis

et al. 2013

The Journal of Spinal Cord Medicine

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“…DBS for chronic pain has been undertaken for over half a century [15,16,17,18,19,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41], its use preceding the ‘gate theory' by a decade. However, multiple reports had conveyed an overall impression regarding DBS for pain that had led most neurosurgeons to abandon the technique [15,41].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Chronic Intractable Neuropathic Pain

Son

Kim

et al. 2014

Stereotact Funct Neurosurg

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Background/Objectives: Both motor cortex stimulation (MCS) and deep brain stimulation (DBS) of the ventralis caudalis (Vc) thalamus have been shown to be effective in chronic neuropathic pain, and the modulation of thalamic and thalamocortical activity is regarded as a possible mechanism. Although Vc DBS and MCS have a common analgesic mechanism, the application of MCS and DBS is still considered empirical, and there is no consensus on which method is better. Methods: We performed a simultaneous trial of thalamic Vc DBS and MCS in 9 patients with chronic neuropathic pain and investigated the results of the stimulation trial and long-term pain relief. Results: Of the 9 patients initially implanted with both DBS and MCS electrodes, 8 (89%) had a successful trial; 6 of these 8 patients (75%) responded to MCS, and the remaining 2 responded to Vc DBS. During the long-term follow-up, the mean numeric rating scale score decreased significantly (p < 0.05). The percentages of pain relief in the chronic MCS group and the chronic DBS group were 37.9 ± 16.5 and 37.5%, respectively, and there was no statistically significant difference (p = 0.157). Conclusion: Considering the initial success rate and the less invasive nature of epidural MCS compared with DBS, we think that MCS would be a more reasonable initial means of treatment for chronic intractable neuropathic pain.

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“…The most recent study reporting satisfactory results occurred in 1995, when Tasker and Vilela Filho [7] achieved success in 3 out of 6 patients with implantations in “parasthesia-producing” sites which consisted of somatosensory areas. In 2006 a trial was conducted in 11 DRS patients with both PVG and VPL electrodes, and this was the largest cohort since 1987 [59].…”

Section: Methodsmentioning

confidence: 99%

“…Accounting for the 7 patients who achieved no pain relief brings the average reduction closer to 26%. Tasker and Vilela Filho [7] found that a trial of PAG/PVG stimulation did not produce pain relief in DRS patients, and in fact it evoked unpleasant effects in nearly all of the patients.…”

Section: Methodsmentioning

confidence: 99%

“…The syndrome is thought to be a manifestation of spinothalamic dysfunction, and it has been shown that the relative volume of the spinothalamic pathway in DRS patients is significantly lower than that of controls [6]. Though traditionally characterized as requiring dyesthesia, allodynia, and hyperalgesia [1,2,4,5,7], DRS can also occur in stroke patients with normal sensory processing [8]. While patients can develop DRS with normal sensation, the presence of early evoked pain or dyesthesia in conjunction with reduced cold or pinprick sensations significantly increases the odds of developing DRS [9].…”

Section: Introductionmentioning

confidence: 99%

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Deep Brain Stimulation for the Treatment of Dejerine-Roussy Syndrome

Ward

Mammis²

2017

Stereotact Funct Neurosurg

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Background/Aims: Patients who suffer from Dejerine-Roussy syndrome commonly experience severe poststroke hemibody pain which has historically been attributed to thalamic lesions. Despite pharmacological treatment, a significant proportion of the population is resistant to traditional therapy. Deep brain stimulation is often appropriate for the treatment of resistant populations. In this review we aim to summarize the targets that are used to treat Dejerine-Roussy syndrome and provide insight into their clinical efficacy. Methods: In reviewing the literature, we defined stimulation success as achievement of a minimum of 50% pain relief. Results: Contemporary targets for deep brain stimulation are the ventral posterior medial/ventral posterior lateral thalamic nuclei, periaqueductal/periventricular gray matter, the ventral striatum/anterior limb of the internal capsule, left centromedian thalamic nuclei, the nucleus ventrocaudalis parvocellularis internis, and the posterior limb of the internal capsule. Conclusions: Due to technological advancements in deep brain stimulation, its therapeutic effects must be reevaluated. Despite a lack of controlled evidence, deep brain stimulation has been effectively used as a therapeutic in clinical pain management. Further clinical investigation is needed to definitively evaluate the therapeutic efficacy of deep brain stimulation in treating the drug-resistant patient population.

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Deep Brain Stimulation for Neuropathic Pain

Cited by 59 publications

References 0 publications

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Chronic Intractable Neuropathic Pain

Deep Brain Stimulation for the Treatment of Dejerine-Roussy Syndrome

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