Psychiatric aspects of thalamic stimulation for neuropathic pain

Twenty-four patients with neuropathic pain underwent thalamic stimulation after conventional surgical and medical treatments had failed. Psychiatric interviews and psychometric testing were carried out before and after surgery to screen candidates and to assess therapeutic response. Eighteen patients obtained either complete or partial pain relief by regular stimulation. Because of technical problems surgery was unsuccessful in 6 patients. Predictions of outcome by the psychiatrist based on the patient's premorbid personality traits, alcohol and narcotic abuse, psychopathology at interview, and psychosocial stressors showed no correlation with these surgical results. When surgery failed, therapeutic intervention was needed for severe disappointment and suicidal behaviour. In follow-up studies 2 of the 6 patients with continuing pain have died by suicide. When surgery succeeded, patients returned to a near normal and satisfactory way of life. Thalamic stimulation offers a promising alternative treatment for intractable neuropathic pain.