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Deep Brain Stimulation for Facial Pain.

William G B Singleton1, Reiko Ashida1, Nikunj K Patel2

  • 1Department of Functional and Stereotactic Neurosurgery, North Bristol Trust, Bristol, United Kingdom.

Progress in Neurological Surgery
|September 9, 2020
PubMed
Summary
This summary is machine-generated.

Deep brain stimulation (DBS) is an established treatment for movement disorders. While historically effective for pain, challenges in patient selection and technique led to its decline, though it remains a last resort for intractable facial pain.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Pain Management

Background:

  • Deep brain stimulation (DBS) is a standard treatment for movement disorders like Parkinson's disease, dystonia, and obsessive-compulsive disorder.
  • Historically, DBS was used for intractable pain syndromes, particularly facial pain, targeting the somatosensory thalamus.
  • DBS for pain lost favor in the late 1990s due to trial failures, patient selection issues, and inconsistent surgical techniques.

Purpose of the Study:

  • To review the historical and current applications of DBS for pain management.
  • To highlight the challenges and successes of DBS in treating various chronic pain conditions, especially facial pain.
  • To emphasize the need for a better understanding of DBS mechanisms for optimizing pain treatment outcomes.

Main Methods:

  • Review of historical and current literature on Deep Brain Stimulation (DBS) for pain management.
  • Analysis of clinical success and challenges associated with DBS for various neuropathic and nociceptive pain syndromes.
  • Examination of patient selection criteria and neurosurgical techniques in DBS for pain.

Main Results:

  • DBS has demonstrated clinical success in treating a range of chronic facial pain syndromes resistant to conventional treatments.
  • Conditions treated include trigeminal neuropathy, post-herpetic neuralgia, and cluster headaches, often as a last treatment option.
  • Despite past setbacks, DBS remains a viable, albeit investigational or off-label, approach for specific intractable pain cases.

Conclusions:

  • Deep brain stimulation (DBS) is a valuable, albeit last-resort, option for managing severe facial pain syndromes.
  • Addressing past criticisms regarding patient selection and surgical technique is crucial for improving DBS efficacy in pain.
  • Further research into the mechanisms of action of DBS for pain is essential for refining treatment strategies and identifying new brain targets.