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Neurosurgery. 2019 Feb 25. pii: nyy552. doi: 10.1093/neuros/nyy552. [Epub ahead of print]

Deep Brain Stimulation for Pain in the Modern Era: A Systematic Review.

Author information

1
Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
2
Post-graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
3
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
4
Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
5
Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio.
6
Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.

Abstract

BACKGROUND:

Deep brain stimulation (DBS) has been considered for patients with intractable pain syndromes since the 1950s. Although there is substantial experience reported in the literature, the indications are contested, especially in the United States where it remains off-label. Historically, the sensory-discriminative pain pathways were targeted. More recently, modulation of the affective sphere of pain has emerged as a plausible alternative.

OBJECTIVE:

To systematically review the literature from studies that used contemporary DBS technology. Our aim is to summarize the current evidence of this therapy.

METHODS:

A systematic search was conducted in the MEDLINE, EMBASE, and Cochrane libraries through July 2017 to review all studies using the current DBS technology primarily for pain treatment. Study characteristics including patient demographics, surgical technique, outcomes, and complications were collected.

RESULTS:

Twenty-two articles were included in this review. In total, 228 patients were implanted with a definitive DBS system for pain. The most common targets used were periaqueductal/periventricular gray matter region, ventral posterior lateral/posterior medial thalamus, or both. Poststroke pain, phantom limb pain, and brachial plexus injury were the most common specific indications for DBS. Outcomes varied between studies and across chronic pain diagnoses. Two different groups of investigators targeting the affective sphere of pain have demonstrated improvements in quality of life measures without significant reductions in pain scores.

CONCLUSION:

DBS outcomes for chronic pain are heterogeneous thus far. Future studies may focus on specific pain diagnosis rather than multiple syndromes and consider randomized placebo-controlled designs. DBS targeting the affective sphere of pain seems promising and deserves further investigation.

KEYWORDS:

Chronic pain; Deep brain stimulation; Neurosurgical procedures; Pain; Pain management; Review

PMID:
30799493
DOI:
10.1093/neuros/nyy552

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