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Deep brain stimulation for neuropathic pain

R R Tasker1, O Vilela Filho

  • 1Toronto Hospital, Western Division, Division of Neurosurgery, Ont., Canada.

Stereotactic and Functional Neurosurgery
|January 1, 1995
PubMed
Summary
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Paresthesia-producing deep brain stimulation (DBS) effectively treated neuropathic pain. Periventricular grey DBS was less effective for pain but helped specific symptoms like allodynia in stroke patients.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pain Management

Background:

  • Neuropathic pain is a challenging condition often refractory to conventional treatments.
  • Deep brain stimulation (DBS) is an emerging therapy for chronic pain.
  • Different DBS targets may have varying efficacies and side effect profiles.

Purpose of the Study:

  • To compare the effectiveness of paresthesia-producing (PP) DBS versus periventricular grey (PVG) DBS for neuropathic pain.
  • To investigate the impact of DBS on specific pain symptoms like allodynia and hyperpathia.
  • To evaluate patient tolerance and response based on prior treatments.

Main Methods:

  • A cohort of 25 patients with neuropathic pain received both PP-DBS and PVG-DBS.
  • Pain relief, paresthesia production, and specific symptoms (allodynia, hyperpathia) were assessed.

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  • Patient responses were analyzed in relation to prior dorsal column stimulation (DCS) outcomes.

    • Main Results:

    • PP-DBS was effective for steady neuropathic pain in most patients, irrespective of stimulation site.
    • PVG-DBS did not effectively treat steady pain but suppressed allodynia/hyperpathia in three stroke-induced pain cases.
    • PP-DBS was perceived as unpleasant in 35% of stroke-induced central pain patients with allodynia/hyperpathia.
    • Response to PP-DBS varied based on prior DCS outcomes, with better response in those lacking paresthesia from DCS.

    Conclusions:

    • Paresthesia-producing DBS is a viable option for managing neuropathic pain.
    • Periventricular grey DBS may offer specific benefits for certain pain-related symptoms, particularly in stroke-induced pain.
    • Patient selection and prior treatment responses, like with DCS, are important factors in predicting DBS success.