Motor cortex stimulation for intractable pain

Effective management of neuropathic pain is one of the more challenging endeavors for even the most experienced and skilled pain specialist. Pharmacological therapy is frequently ineffective and/or poorly tolerated, especially in elderly patients. Many if not most surgical procedures have yielded limited success in the treatment of these pain conditions. Motor cortex stimulation (MCS) has emerged as a promising technique for the management of pain in patients with difficult neuropathic and central pain conditions. Although MCS has proven most successful for patients with trigeminal neuropathic/deafferentation pain and central poststroke pain, other conditions are now emerging as potential targets for this therapy. Based on previous as well as ongoing work, it would appear that the future of MCS is indeed bright. Hopefully, as work continues in this area, investigators will be able to develop a better understanding of the mechanisms underlying this modality and be able to further refine the technique of MCS. It is also possible that with the use of noninvasive tools such as transcranial magnetic stimulation, practitioners will be able to predict with accuracy which patients are likely to respond favorably to MCS.