DBS for Persistent Non-Cancer Pain

Hamani, Clement; Fontaine, Denys; Lozano, A.

doi:10.1007/978-3-540-69960-6_131

Cited by 10 publications

(9 citation statements)

References 88 publications

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“…Regarding the implantation of intracranial electrodes, there have been great advances that have modified the surgical placement techniques and improved intra- and postoperative control. We refer to the use of CT and MRI fusion programs [ 249 ] and new neuronavigation software, including the different stereotactic atlases [ 250 ]. In addition, improvements in intraoperative neurophysiological exploration, through prior recording with microelectrodes, compared to classic stimulation with implantable macroelectrodes, should also be mentioned [ 251 ].…”

Section: Neurosurgical Proceduresmentioning

confidence: 99%

“…In addition, improvements in intraoperative neurophysiological exploration, through prior recording with microelectrodes, compared to classic stimulation with implantable macroelectrodes, should also be mentioned [ 251 ]. Microelectrode recording and stimulation are very useful at the level of the sensory thalamic nuclei, in which there is a somatotopic distribution; however, it is not as useful as at the PAG-PVG level [ 250 ].…”

Section: Neurosurgical Proceduresmentioning

confidence: 99%

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Neurosurgical Treatment of Pain

Sola

Pulido

2022

Brain Sciences

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The aim of this review is to draw attention to neurosurgical approaches for treating chronic and opioid-resistant pain. In a first chapter, an up-to-date overview of the main pathophysiological mechanisms of pain has been carried out, with special emphasis on the details in which the surgical treatment is based. In a second part, the principal indications and results of different surgical approaches are reviewed. Cordotomy, Myelotomy, DREZ lesions, Trigeminal Nucleotomy, Mesencephalotomy, and Cingulotomy are revisited. Ablative procedures have a limited role in the management of chronic non-cancer pain, but they continues to help patients with refractory cancer-related pain. Another ablation lesion has been named and excluded, due to lack of current relevance. Peripheral Nerve, Spine Cord, and the principal possibilities of Deep Brain and Motor Cortex Stimulation are also revisited. Regarding electrical neuromodulation, patient selection remains a challenge.

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Section: Neurosurgical Proceduresmentioning

confidence: 99%

Section: Neurosurgical Proceduresmentioning

confidence: 99%

Neurosurgical Treatment of Pain

Sola

Pulido

2022

Brain Sciences

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“…MCS has certain indications, such as: central post stroke pain, neuropathic trigeminal pain, brachial plexus avulsion (principally for continuous pain since paroxysmal pain is managed better with Dorsal Root Entry Zone lesioning) and infrasegmental pain in spinal cord injury. Segmental pain in spinal cord injury is preferentially treated with Dorsal Root Entry Zone lesioning than MCS [11,[13][14][15][16][17][18][19].…”

Section: Neuromodulation Technique Selectionmentioning

confidence: 99%

“…An ambulatory trial is the gold standard and although it can last from three days to three weeks, it is not commonly recommended to be longer than a week because of the infection risk. The positive response to the trial is generally established as a pain relief of at least 50% according to the visual analog scale (VAS) as well as patient satisfaction [1,5,14,15,20].…”

Section: Trialmentioning

confidence: 99%

Practical Tips in Neuromodulation for Pain

Bendersky¹

2018

ACCMJ

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This paper tries to help physicians involved in neuromodulation techniques in achieving better results. Patient selections, trial period as well as the neuromodulation technique selection itself are discussed. Initial stimulation parameters for spinal cord stimulation, motor cortex stimulation and peripheral nerve field stimulation are suggested in the text.Neuromodulation techniques must be used properly since its misusage may lead them to failure and to become less accepted into the medical community.

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“…El mecanismo de acción no se conoce completamente aunque se postulan como hipótesis, una estimulación de las vías inhibitorias corticofugales capaces de inhibir la transmisión del estímulo doloroso en el caso de la estimulación talámica y de la cápsula, y una liberación de opioides endógenos, junto con una activación del tálamo medial y la parte anterior del cíngulo en la estimulación de las otras estructuras (36). La estimulación hipotalámica es capaz de modular la actividad del núcleo descendente del trigémino influyendo así en el reflejo trigeminal causante de la cefalea en racimos (35).…”

Section: Estimulación Cerebral Profundaunclassified

Neuromodulación eléctrica y dolor raquídeo

García-March

García-Catalán

2015

Rev. Soc. Esp. Dolor

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The pain of spinal origin is a pathological condition with a significant incidence and prevalence and enormous social and health impact. The different electrical neuromodulation techniques can be considered an effective and safe alternative for the treatment of these patients. In the present review, we deep from the etiological and pathophysiological in spinal pain, especially in the syndrome of failed spinal surgery. We describe the surgical implantation technique, its indications and results achieved until now. We will also summarize the possible mechanisms of action of different types of electrical neurostimulation. Finally, we will comment on the dificulties and inconvinients that did not allow this pain surgical alternative to become more widely used. RESUMENEl dolor de origen raquídeo es un cuadro patológico con una importante incidencia y prevalencia y un enorme impacto socio-sanitario. La incorporación de las diferentes técnicas de neuromodulación eléctrica en el tratamiento de estos pacientes se ha mostrado como una alternativa terapéutica novedosa, segura y eficaz. El presente trabajo de revisión pretende profundizar desde el punto de vista etiológico y fisiopatológico en el dolor raquídeo, y sobre todo en el síndrome de cirugía fallida espinal. Se intentará acercar la técnica quirúrgica de implantación, comentar las indicaciones y resultados obtenidos hasta la actualidad, y realizar una aproximación crítica a los posibles mecanismos de acción de las diferentes modalidades de neuroestimulación eléctrica. Finalmente, se comentarán cuáles han sido los problemas e inconvenientes que han impedido la utilización generalizada de esta alternativa quirúrgica en estos procesos.Palabras clave: Dolor raquídeo. Fisiopatología. Neuroestimulación eléctrica. Técnicas y resultados. Mecanismos de acción. INTRODUCCIÓNEl dolor de origen raquídeo es un cuadro patológico con una importante incidencia y prevalencia. Se estima que un 80% de la población lo sufre en algún momento de su vida, concretándose en diferentes estudios que la prevalencia de lumbalgia crónica entre los adultos españoles es del 7,7%, y que la incidencia de la población que acude a una Unidad de Dolor en España por problemas de dolor raquídeo no oncológico es del 55,3% (1,2). Es además un trastorno con un enorme impacto socio-sanitario, con importantes repercusiones psicológicas y económicas tanto en el paciente que lo sufre como en la sociedad que tiene que sufragar los gastos que el mismo supone.En la actualidad existe un enorme abanico de posibles soluciones quirúrgicas a los diferentes problemas raquí-deos que, en general, deben ser abordados de forma multidisciplinar. Sin embargo queda un grupo de pacientes con dolor en los que la cirugía convencional no ofreceRecibido: 01-03-13. Aceptado: 15-05-14.

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DBS for Persistent Non-Cancer Pain

Cited by 10 publications

References 88 publications

Neurosurgical Treatment of Pain

Neurosurgical Treatment of Pain

Practical Tips in Neuromodulation for Pain

Neuromodulación eléctrica y dolor raquídeo

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