Combined electrical stimulation of the periaqueductal gray matter and sensory thalamus

11 patients with chronic intractable pain of at least 3 years' duration underwent a morphine infusion test, the results of which suggested a syndrome of superimposed somatogenic and neurogenic pain components. They then underwent stereotactic implantation of a dual-channel brain stimulation system with two brain electrodes, one in the left periaqueductal gray matter (PAG) and the other in the sensory thalamus contralateral to the neurogenic pain. Using this system, all patients have obtained excellent simultaneous relief of both pain components (follow-up 12-36 months). The findings support a notion of two separate sensory modulating systems. They indicate that combined electrical stimulation of the PAG and sensory thalamus is a technically feasible and clinically satisfactory modality for the control of pain in humans, and they appear to indicate that better pain control is obtained by continuous, cycled stimulation of the PAG than by the conventional mode of stimulation.