Deep Brain Stimulation for Neuropathic Pain
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INTRODUCTION
Chronic intractable pain has been treated by electrical stimulation of deep brain structures for the past half century (1,2). Initially, the septal area (1) and caudate nucleus (3) constituted the most popular anatomical structures for stimulation. The number of surgical targets increased over the next few decades, a result of variable clinical outcomes with previously described stimulation sites, and an escalating understanding of the anatomical substrates involved in the processing of pain
METHODS
Thirty-four patients (24 men, 10 women) with intractable neuropathic pain were selected for surgery, on the basis of their clinical evaluation. In all patients the pain had a definable organic origin (Table 1). All reasonable conventional pain management techniques had failed or were poorly tolerated. Patients with psychiatric disturbances, such as psychotic illness and severe depression, were excluded. This pain was refractory to multiple pharmacologic and nonpharmacologic therapies, including
Results of Trial Stimulation
Of the 34 patients selected for trial stimulation, 26 patients (76%) proceeded to permanent implantation. This is summarized in Table 2. The mean age of patients proceeding to permanent implantation was 50.4 years. Patients suffering from poststroke pain were the most likely to fail trial stimulation (31%), in contrast to individuals with phantom limb (one upper, two lower limb)/postbrachial plexus injury pain and anesthesia dolorosa, all of whom underwent permanent implantation.
Pain Alleviation
The outcome
DISCUSSION
This study reports the outcome of deep brain stimulation of the sensory thalamus and the PVG/PAG complex for different neuropathic pain syndromes. We believe that this single-center prospective study shows a beneficial effect of such therapy for neuropathic pain syndromes. However, the outcomes of surgery appear to vary according to etiology. Our conclusions must be taken in the light of the fact that certain etiologies are of a smaller number than others. It would appear that the effects are
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Financial Support: Sarah Owen and Shouyan Wang are supported by the Norman Collison Foundation. Tipu Aziz is supported by the Medical Research Council, UK.