Deep Brain Stimulation for the Treatment of Various Chronic Pain Syndromes
Deep Brain Stimulation for the Treatment of Various Chronic Pain Syndromes
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.
The treatment of chronic pain syndromes includes pharmacological, physiotherapeutic, and invasive methods and techniques. One of the invasive methods is the stimulation of deep brain areas like the thalamus or the periventricular region with implanted electrodes. Because of its invasiveness and the risks associated with DBS, it is restricted to a selected group of patients in whom conservative treatment of chronic pain syndromes has been ineffective. The technique of DBS has been used since the 1950s, and experience regarding the indications and long-term results has been gained at different centers worldwide. To date more than 450 cases have been reported in the literature, and long-term results with a follow-up period of more than 15 years have also been documented.
In this series we demonstrate our results in 56 patients with different chronic pain syndromes. A review of the current literature is included in the Discussion. The patients in this series underwent a rigorous selection and testing protocol, including a double-blinded evaluation during the testing trial, and an intensity-dependent test stimulation. The results are presented in relation to clinical diagnoses.
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.
The treatment of chronic pain syndromes includes pharmacological, physiotherapeutic, and invasive methods and techniques. One of the invasive methods is the stimulation of deep brain areas like the thalamus or the periventricular region with implanted electrodes. Because of its invasiveness and the risks associated with DBS, it is restricted to a selected group of patients in whom conservative treatment of chronic pain syndromes has been ineffective. The technique of DBS has been used since the 1950s, and experience regarding the indications and long-term results has been gained at different centers worldwide. To date more than 450 cases have been reported in the literature, and long-term results with a follow-up period of more than 15 years have also been documented.
In this series we demonstrate our results in 56 patients with different chronic pain syndromes. A review of the current literature is included in the Discussion. The patients in this series underwent a rigorous selection and testing protocol, including a double-blinded evaluation during the testing trial, and an intensity-dependent test stimulation. The results are presented in relation to clinical diagnoses.
