Deep brain stimulation of the dorsal anterior cingulate cortex for the treatment of chronic neuropathic pain

Abstract

<jats:p>Chronic neuropathic pain is estimated to affect 3%-4.5% of the worldwide population. It is associated with significant loss of productive time, withdrawal from the workforce, development of mood disorders such as depression and anxiety, and disruption of family and social life. Current medical therapeutics often fail to adequately treat chronic neuropathic pain. Deep brain stimulation (DBS) targeting subcortical structures such as the periaqueductal gray, the ventral posterior lateral and medial thalamic nuclei, and the internal capsule has been investigated for the relief of refractory neuropathic pain over the past 3 decades. Recent work has identified the dorsal anterior cingulate cortex (dACC) as a new potential neuromodulation target given its central role in cognitive and affective processing. In this review, the authors briefly discuss the history of DBS for chronic neuropathic pain in the United States and present evidence supporting dACC DBS for this indication. They review existent literature on dACC DBS and summarize important findings from imaging and neurophysiological studies supporting a central role for the dACC in the processing of chronic neuropathic pain. The available neurophysiological and empirical clinical evidence suggests that dACC DBS is a viable therapeutic option for the treatment of chronic neuropathic pain and warrants further investigation.</jats:p>

High-resolution functional MRI identified distinct global intrinsic functional networks of nociceptive posterior insula and S2 regions in squirrel monkey brain

“…ACC is linked to the affective processing of pain, and also likely serves as an important relay station in descending inhibitory control of pain (Bingel et al, 2006; Lieberman and Eisenberger, 2015; Qu et al, 2011; Rainville et al, 1997; Rance et al, 2014; Russo and Sheth, 2015). PF has been proposed as a modulatory area for pain (Hardy and Haigler, 1985; Jahn et al, 2016; Lorenz et al, 2003; Nardone et al, 2017; Wiech et al, 2006).…”

The role of the dorsal Anterior Cingulate Cortex (dACC) in a cognitive and emotional counting Stroop task: Two cases

“…deep brain stimulation, TMS) for the treatment of various disorders including obsessive-compulsive disorders, pain, addiction, and tinnitus (e.g. (Brown et al, 2016;Bush et al, 1999;De Ridder, Joos, & Vanneste, 2016;De Ridder, Leong, Manning, Vanneste, & Glue, 2017;De Ridder, Vanneste, Kovacs, Sunaert, & Dom, 2011;Russo & Sheth, 2015;Tzabazis et al, 2013)), pointing to a more general role of the dACC than involvement in cognitive processing alone. Moreover, the dACC as part of the 'salience network' has been identified as the 'psychiatric core' or one of the core brain regions affected across most psychiatric disorders (Downar, Blumberger, & Daskalakis, 2016;Goodkind et al, 2015).…”

Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain

“…In this carefully selected subset of patients, small but increasing evidence indicates that stereotactic anterior cingulotomy could be an effective treatment option [8,9]. The dorsal anterior cingulate cortex is considered part of the limbic circuit and is thought to have a major role in cognitive and emotional processing, as well as the perception of pain [10]. Functional neuroimaging studies have contributed to the idea that the dorsal anterior cingulate cortex takes part in modulation of nociceptive information received by somatosensory areas [11,12,13,14].…”