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Deep brain stimulation for phantom limb pain.

Richard G Bittar1, Sofia Otero, Helen Carter

  • 1Department of Neurosurgery, Radcliffe Infirmary, Oxford, UK. neurosurgeon@ampsclinic.com

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|June 1, 2005
PubMed
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Deep brain stimulation effectively reduced phantom limb pain intensity by 62% and improved quality of life in three patients. This treatment offers significant relief for chronic neuropathic pain following amputation.

Area of Science:

  • Neurology
  • Pain Medicine
  • Neurosurgery

Background:

  • Phantom limb pain affects up to 85% of amputees, with poorly understood pathophysiology.
  • Both peripheral and central nervous system mechanisms are implicated in pain modulation.
  • The neuromatrix theory suggests abnormal reorganization within the brain's body image representation contributes to phantom limb pain.

Purpose of the Study:

  • To assess the clinical outcomes of deep brain stimulation (DBS) for chronic neuropathic phantom limb pain.
  • To evaluate the efficacy of stimulating the periventricular gray matter and somatosensory thalamus.
  • To measure changes in pain intensity, quality of pain, and quality of life.

Main Methods:

  • Deep brain stimulation (DBS) targeting the periventricular gray matter and somatosensory thalamus was performed in three patients.

Related Experiment Videos

  • Patients were assessed preoperatively and at 3-month intervals postoperatively.
  • Pain intensity (visual analogue scale), pain quality (McGill Pain Questionnaire), and quality of life (EUROQOL EQ-5D) were evaluated.

    • Main Results:

    • A mean pain intensity reduction of 62% (range 55-70%) was observed at follow-up (mean 13.3 months).
    • The burning component of pain was completely alleviated in all patients.
    • Quality of life showed a statistically significant improvement, and opiate intake was reduced in two patients.

    Conclusions:

    • Deep brain stimulation (DBS) of the periventricular gray matter and somatosensory thalamus is a viable treatment option for phantom limb pain.
    • DBS can significantly reduce pain intensity, improve pain quality, and enhance the quality of life for amputees.
    • Further research and clinical application of DBS are supported by these findings for managing chronic neuropathic pain.