Deep brain stimulation for the treatment of various chronic pain syndromes

Dirk Rasche M.D., Patricia C. Rinaldi Ph.D., Ronald F. Young M.D., and Volker M. Tronnier M.D., Ph.D.
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Object

Electrical intracerebral stimulation (also referred to as deep brain stimulation [DBS]) is a tool for the treatment of chronic pain states that do not respond to less invasive or conservative treatment options. Careful patient selection, accurate target localization, and identification with intraoperative neurophysiological techniques and blinded test evaluation are the key requirements for success and good long-term results. The authors present their experience with DBS for the treatment of various chronic pain syndromes.

Methods

In this study 56 patients with different forms of neuropathic and mixed nociceptive/neuropathic pain syndromes were treated with DBS according to a rigorous protocol. The postoperative follow-up duration ranged from 1 to 8 years, with a mean of 3.5 years. Electrodes were implanted in the somatosensory thalamus and the periventricular gray region. Before implantation of the stimulation device, a double-blinded evaluation was carefully performed to test the effect of each electrode on its own as well as combined stimulation with different parameter settings.

The best long-term results were attained in patients with chronic low-back and leg pain, for example, in so-called failed–back surgery syndrome. Patients with neuropathic pain of peripheral origin (such as complex regional pain syndrome Type II) also responded well to DBS. Disappointing results were documented in patients with central pain syndromes, such as pain due to spinal cord injury and poststroke pain. Possible reasons for the therapeutic failures are discussed; these include central reorganization and neuroplastic changes of the pain-transmitting pathways and pain modulation centers after brain and spinal cord lesions.

Conclusions

The authors found that, in carefully selected patients with chronic pain syndromes, DBS can be helpful and can add to the quality of life.

Abbreviations used in this paper:

CRPS II = complex regional pain syndrome Type II; DBS = deep brain stimulation; FBSS = failed–back surgery syndrome; IPG = implantable pulse generator; PAG = periaqueductal gray region; PVG = periventricular gray region; SCS = spinal cord stimulation; VAS = visual analog scale; VPL = ventral posterior lateral nucleus; VPM = ventral posterior medial nucleus.

Object

Electrical intracerebral stimulation (also referred to as deep brain stimulation [DBS]) is a tool for the treatment of chronic pain states that do not respond to less invasive or conservative treatment options. Careful patient selection, accurate target localization, and identification with intraoperative neurophysiological techniques and blinded test evaluation are the key requirements for success and good long-term results. The authors present their experience with DBS for the treatment of various chronic pain syndromes.

Methods

In this study 56 patients with different forms of neuropathic and mixed nociceptive/neuropathic pain syndromes were treated with DBS according to a rigorous protocol. The postoperative follow-up duration ranged from 1 to 8 years, with a mean of 3.5 years. Electrodes were implanted in the somatosensory thalamus and the periventricular gray region. Before implantation of the stimulation device, a double-blinded evaluation was carefully performed to test the effect of each electrode on its own as well as combined stimulation with different parameter settings.

The best long-term results were attained in patients with chronic low-back and leg pain, for example, in so-called failed–back surgery syndrome. Patients with neuropathic pain of peripheral origin (such as complex regional pain syndrome Type II) also responded well to DBS. Disappointing results were documented in patients with central pain syndromes, such as pain due to spinal cord injury and poststroke pain. Possible reasons for the therapeutic failures are discussed; these include central reorganization and neuroplastic changes of the pain-transmitting pathways and pain modulation centers after brain and spinal cord lesions.

Conclusions

The authors found that, in carefully selected patients with chronic pain syndromes, DBS can be helpful and can add to the quality of life.

Abbreviations used in this paper:

CRPS II = complex regional pain syndrome Type II; DBS = deep brain stimulation; FBSS = failed–back surgery syndrome; IPG = implantable pulse generator; PAG = periaqueductal gray region; PVG = periventricular gray region; SCS = spinal cord stimulation; VAS = visual analog scale; VPL = ventral posterior lateral nucleus; VPM = ventral posterior medial nucleus.

Contributor Notes

Address reprint requests to: Dirk Rasche, M.D., Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. email: dirk.rasche@uk-sh.de.

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