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Deep brain stimulation for neuropathic pain.

S L F Owen1, A L Green, D D Nandi

  • 1University Laboratory of Physiology, University of Oxford, Oxford, UK.

Acta Neurochirurgica. Supplement
|August 19, 2007
PubMed
Summary
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Deep brain stimulation (DBS) effectively treats intractable neuropathic pain, particularly for phantom limb and anesthesia dolorosa. While outcomes vary by cause, PVG/PAG stimulation offers significant pain relief.

Area of Science:

  • Neurosurgery
  • Pain Management
  • Neurology

Background:

  • Deep brain stimulation (DBS) is an established therapy for intractable pain.
  • The sensory thalamus and periventricular/periaqueductal gray (PVG/PAG) complex are key targets for pain modulation.

Purpose of the Study:

  • To evaluate the efficacy of DBS targeting the sensory thalamus and PVG/PAG complex for various neuropathic pain syndromes.
  • To identify factors influencing treatment outcomes based on pain etiology.

Main Methods:

  • Retrospective analysis of 47 patients with intractable neuropathic pain undergoing trial DBS.
  • Surgical implantation of permanent DBS devices for 38 patients who responded favorably to trial stimulation.
  • Assessment of pain reduction and patient outcomes stratified by pain type.

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Main Results:

  • Overall, 38 of 47 patients proceeded to permanent DBS implantation.
  • Periventricular/periaqueductal gray (PVG/PAG) stimulation alone provided optimal pain relief in 53% of patients, with a mean improvement of 59%.
  • Efficacy varied by pain etiology, with best outcomes observed in phantom limb pain, head pain, and anesthesia dolorosa. Post-stroke pain showed a 70% response rate.

Conclusions:

  • DBS of the sensory thalamus and PVG/PAG complex is a viable treatment for intractable neuropathic pain.
  • Treatment outcomes are significantly influenced by the underlying cause of the pain.
  • PVG/PAG stimulation, alone or in combination with thalamic stimulation, demonstrates considerable analgesic effects.