Intracranial stimulation for the control of chronic pain

Long-term stimulation of deep brain structures for pain relief has been efficacious in a significant number of patients who have been total failures at every other means of pain control. Two primary sites are used at this time--the periventricular grey area, which is related to the endogenous opiate system, and the internal capsule system, which is related to the dorsal column projection system. Periventricular sites are more efficacious for externally generated pain, that is, pain with input through the dorsal horn. Internal capsule stimulation is more efficacious for central nervous system-generated pain. While the preoperative preparation and intraoperative testing as well as postoperative testing of these patients requires a great deal of time and tedious attention to detail, our long-term results have been excellent using a combined comprehensive pain unit approach to pain and stress management, plus the stimulation techniques in carefully selected patients. Our results would indicate that initially 80-85% of patients get good pain relief, and then that range decreases to between 50 and 60% over a long period of time. Deep brain stimulation for pain relief is not a technique that should be used on a large number of patients with simple pain problems, but is highly efficacious in a selected group of patients with very specific pain problems that do not respond to usual pain treatment techniques. In patients with pain generated by benign etiologies, it is far superior to destructive procedures and does not have the secondary side effects of sensory loss, postchordotomy dysesthesias, or secondary neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)