Deep brain stimulation versus motor cortex stimulation for neuropathic pain: A minireview of the literature and proposal for future research

Honey, C Michael; Tronnier, V.; Honey, Christopher R.

doi:10.1016/j.csbj.2016.06.003

Cited by 36 publications

(28 citation statements)

References 27 publications

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“…The limbic pathways profoundly modulate how pain is perceived. Depression, for example, can increase the subjective experience of pain . Conversely, cingulotomy (surgical disruption of the limbic pathway) can reduce the suffering component of pain .…”

Section: Discussionmentioning

confidence: 99%

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Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial

Ivanishvili

Poologaindran

Honey

2017

Neuromodulation: Technology at the Neural Interface

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Section: Discussionmentioning

confidence: 99%

“…Due to the complexity of neuropathic pain and MCS, larger collaborative trials will be required to answer these fundamental questions: who should get surgery, how should it be performed and, equally importantly, how should they be stimulated? .…”

Section: Discussionmentioning

confidence: 99%

Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial

Ivanishvili

Poologaindran

Honey

2017

Neuromodulation: Technology at the Neural Interface

Self Cite

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“…It is not uncommon practice to enroll patients withmixed pain etiologies, many of which are pathophysiologically distinct from DRS, into larger DBS trials. These heterogeneous cohorts produce variable responses which do not extrapolate well to clinical practice [26,85]. In the Medtronic DBS trial, one of the largest explorations into the efficacy of DBS, their patient population consisted of at least 15 different causes, many of which responded poorly to DBS [34,85].…”

Section: Discussionmentioning

confidence: 99%

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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“…This is important because there is no consensus on how DBS operations should be undertakenslight differences in surgical technique or postoperative stimulation parameters may have important effects on pain; there is also no agreement on how the outcomes of DBS treatment should be evaluated. 27…”

Section: Invasive Brain Stimulation Therapiesmentioning

confidence: 99%

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

Corbett

South

Harden

et al. 2018

Health Technol Assess

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Background Although many treatments exist for phantom limb pain (PLP), the evidence supporting them is limited and there are no guidelines for PLP management. Brain and spinal cord neurostimulation therapies are targeted at patients with chronic PLP but have yet to be systematically reviewed. Objective To determine which types of brain and spinal stimulation therapy appear to be the best for treating chronic PLP. Design Systematic reviews of effectiveness and epidemiology studies, and a survey of NHS practice. Population All patients with PLP. Interventions Invasive interventions – deep brain stimulation (DBS), motor cortex stimulation (MCS), spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation. Non-invasive interventions – repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Main outcome measures Phantom limb pain and quality of life. Data sources Twelve databases (including MEDLINE and EMBASE) and clinical trial registries were searched in May 2017, with no date limits applied. Review methods Two reviewers screened titles and abstracts and full texts. Data extraction and quality assessments were undertaken by one reviewer and checked by another. A questionnaire was distributed to clinicians via established e-mail lists of two relevant clinical societies. All results were presented narratively with accompanying tables. Results Seven randomised controlled trials (RCTs), 30 non-comparative group studies, 18 case reports and 21 epidemiology studies were included. Results from a good-quality RCT suggested short-term benefits of rTMS in reducing PLP, but not in reducing anxiety or depression. Small randomised trials of tDCS suggested the possibility of modest, short-term reductions in PLP. No RCTs of invasive therapies were identified. Results from small, non-comparative group studies suggested that, although many patients benefited from short-term pain reduction, far fewer maintained their benefits. Most studies had important methodological or reporting limitations and few studies reported quality-of-life data. The evidence on prognostic factors for the development of chronic PLP from the longitudinal studies also had important limitations. The results from these studies suggested that pre-amputation pain and early PLP intensity are good predictors of chronic PLP. Results from the cross-sectional studies suggested that the proportion of patients with severe chronic PLP is between around 30% and 40% of the chronic PLP population, and that around one-quarter of chronic PLP patients find their PLP to be either moderately or severely limiting or bothersome. There were 37 responses to the questionnaire distributed to clinicians. SCS and DRG stimulation are frequently used in the NHS but the prevalence of use of DBS and MCS was low. Most responders considered SCS and DRG stimulation to be at least sometimes effective. Neurosurgeons had mixed views on DBS, but most considered MCS to rarely be effective. Most clinicians thought that a randomised trial design could be successfully used to study neurostimulation therapies. Limitation There was a lack of robust research studies. Conclusions Currently available studies of the efficacy, effectiveness and safety of neurostimulation treatments do not provide robust, reliable results. Therefore, it is uncertain which treatments are best for chronic PLP. Future work Randomised crossover trials, randomised N-of-1 trials and prospective registry trials are viable study designs for future research. Study registration The study is registered as PROSPERO CRD42017065387. Funding The National Institute for Health Research Health Technology Assessment programme.

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Deep brain stimulation versus motor cortex stimulation for neuropathic pain: A minireview of the literature and proposal for future research

Cited by 36 publications

References 27 publications

Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial

Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial

Deep Brain Stimulation for the Treatment of Dejerine-Roussy Syndrome

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

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