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Neuropathic pain and deep brain stimulation.

Erlick A C Pereira1, Tipu Z Aziz

  • 1Oxford Functional Neurosurgery and Experimental Neurology Group, Department of Neurological Surgery and Nuffield Department of Surgical Sciences, Oxford University, John Radcliffe Hospital, Oxford, OX3 9DU, UK, eacp@eacp.co.uk.

Neurotherapeutics : the Journal of the American Society for Experimental Neurotherapeutics
|May 29, 2014
PubMed
Summary

Deep brain stimulation (DBS) offers a viable treatment for refractory neuropathic pain in select patients. Current techniques and neuroimaging improve outcomes for conditions like amputation pain and cephalalgias.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Pain Management

Background:

  • Deep brain stimulation (DBS) is an established treatment for Parkinson's disease.
  • Limited data exists on current DBS efficacy for chronic neuropathic pain using modern technology.

Observation:

  • This study reviews 13 years of DBS experience in 113 patients across two centers.
  • Surgical targets included ventral posterior thalamus, periventricular/periaqueductal gray matter, and rostral anterior cingulate cortex (Cg24).
  • Specific pain conditions like post-amputation, brachial plexus injury, stroke, and cephalalgias showed success.

Findings:

  • DBS is effective in selected chronic pain patients, particularly those with amputation pain, brachial plexus injury, stroke, and cephalalgias.
  • Somatotopic mapping during awake surgery is crucial for thalamic and cingulate targets.
  • Cingulate DBS under general anesthesia is an option for widespread pain or failed prior DBS.

Implications:

  • Neuroimaging and neurophysiological insights may enhance patient selection and DBS efficacy.
  • Findings support the continued use of DBS for refractory chronic pain.
  • Further research with larger trials is warranted to validate these outcomes.