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Deep brain stimulation for pain relief: a meta-analysis.
Richard G Bittar1, Ishani Kar-Purkayastha, Sarah L Owen
1Department of Neurosurgery, Radcliffe Infirmary, Oxford, UK. neurosurgeon@ampsclinic.com
Summary
Deep brain stimulation (DBS) offers significant pain relief for intractable pain, particularly when targeting the periventricular/periaqueductal gray matter. Success rates vary by pain type and stimulation site, highlighting the need for careful patient selection.
Area of Science:
- Neurology
- Neurosurgery
- Pain Management
Background:
- Deep brain stimulation (DBS) has a long history in treating intractable pain.
- Variations in surgical targets and techniques have historically complicated efficacy assessments.
Purpose of the Study:
- To conduct a meta-analysis to better understand the efficacy of DBS for pain relief.
- To synthesize findings from existing studies on DBS for pain management.
Main Methods:
- Searched MEDLINE and EMBASE databases (1966-2003) for studies on DBS for pain.
- Included six studies (1977-1997) meeting specific patient and protocol criteria.
- Analyzed outcomes based on stimulation sites (PVG/PAG, IC, ST) and pain types.
Main Results:
- Highest long-term pain alleviation rates were observed with DBS of the periventricular/periaqueductal gray matter (PVG/PAG) (79%) or combined with sensory thalamus/internal capsule (87%).
- Sensory thalamus (ST) stimulation alone showed lower efficacy (58% long-term success).
- DBS was more effective for nociceptive pain (63%) than deafferentation pain (47%). High success rates were noted for intractable low back pain, phantom limb pain, and neuropathies.
Conclusions:
- Deep brain stimulation is frequently effective for well-selected patients with intractable pain.
- Advances in neuroimaging and neuromodulation may impact the applicability of these findings to current practice.
- Further research is needed to clarify the role of DBS in modern pain management.