Deep brain stimulation for the treatment of various chronic pain syndromes

Rasche, Dirk; Rinaldi, Patricia C.; Young, Ronald F.; Tronnier, V.

doi:10.3171/foc.2006.21.6.10

Cited by 191 publications

(135 citation statements)

References 51 publications

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“…The UK National Institute for Health and Clinical Excellence approves the treatment on the basis of expert opinion and patient-reported outcomes [140]. Several reviews of DBS for chronic pain have been published-many expert, some commentaries, and several systematic [39,40,45,46,59,60,97,98,101,139,.…”

Section: Evidencementioning

confidence: 99%

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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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Section: Evidencementioning

confidence: 99%

“…In the last decade only 6 centers, to our knowledge, have published case series of >6 patients [42][43][44][45][46][47][48][49][50]. Only about 20 groups worldwide have reported long-term efficacy in up to 83 % of patients with follow-ups of up to 6 years (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Neuropathic Pain and Deep Brain Stimulation

Pereira

Aziz

2014

Neurotherapeutics

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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%

“…4 Several targets have been explored for controlling pain, including the septal area, the posterior limb of the internal capsule, the centromedian and parafascicular nuclei, the ventralis caudalis of the thalamus (VC), and the periventricular gray region (PVG). [4][5][6][7] The preferred targets are the PVG and VC due to ease of targeting and efficacy. Stimulation of the PVG and VC for central poststroke pain (CPSP), however, has failure rates ranging from 33% to 82%.…”

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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“…Electrical stimulation and repetitive transcranial magnetic stimulation have been used in clinical situations for treatment of many central nervous system diseases, for example Parkinson's disease (PD) (Fasano et al, 2010), epilepsy (Fisher et al, 2010), depression (Horvath et al,2010) , and chronic pain (Rasche et al, 2006). Deep brain stimulation (DBS) has become a standard clinical therapy for PD patients and it can ameliorate motor function in such individuals, although the mechanism remains poorly understood.…”

Section: Electrical Stimulation and Repetitive Transcranial Magnetic mentioning

confidence: 99%