Deep brain stimulation for chronic pain: a narrative review

Area of Science:

• Neurology
• Neurosurgery
• Pain Management

Background:

• Deep brain stimulation (DBS) was initially developed for chronic pain management.
• While commonly used for movement disorders, DBS has specific indications for refractory neuropathic pain conditions.
• Pain targets for DBS include nociception pathways (thalamus, insula, anterior cingulate) and pain inhibitory pathways (periaqueductal/periventricular grey matter).

Purpose of the Study:

• To review the efficacy of various Deep brain stimulation targets for different types of chronic pain.
• To discuss recently proposed targets and their outcomes in pain management.
• To highlight DBS as a therapeutic option for severe, treatment-resistant neuropathic pain.

Main Methods:

• Review of case series and existing literature on DBS for chronic pain.
• Analysis of outcomes for different DBS targets, including PAG/PVG and thalamic stimulation.
• Discussion of novel targets such as the anterior cingulate and insula.

Main Results:

• PAG/PVG-DBS showed a 63% success rate in nociceptive pain.
• Thalamic-DBS demonstrated a 47% success rate in neuropathic pain.
• Newer targets like the anterior cingulate and insula have shown varied but promising outcomes.

Conclusions:

• Deep brain stimulation remains a viable therapeutic option for severe chronic neuropathic pain refractory to other treatments.
• Continued research is essential to optimize DBS targets, patient selection, and stimulation parameters.
• DBS offers hope for patients with debilitating chronic pain conditions.