Deep brain stimulation for the alleviation of post-stroke neuropathic pain

Owen, Sarah; Green, Alexander L.; Stein, John; Aziz, Tipu Z.

doi:10.1016/j.pain.2005.09.035

Cited by 168 publications

(94 citation statements)

References 11 publications

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“…Only a few imaging studies have attempted to determine the neural basis for any analgesia produced, [67][68][69] but again these methods lend themselves to further study and improvements in our understanding of these additional lines of therapy. Understanding the neural basis of pleasure and relief provides alternative strategies and potential targets for intervention aimed at taking the pain away.…”

Section: Neuroimaging As a Tool For Assessing Drug-induced Analgesia mentioning

confidence: 99%

Neuroimaging as a Tool for Pain Diagnosis and Analgesic Development

Wartolowska

Tracey

2009

Neurotherapeutics

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Summary:Neuroimaging makes it possible to study pain processing beyond the peripheral nervous system, at the supraspinal level, in a safe, noninvasive way, without interfering with neurophysiological processes. In recent years, studies using brain imaging methods have contributed to our understanding of the mechanisms responsible for the development and maintenance of chronic pain. Moreover, neuroimaging shows promising results for analgesic drug development and in characterizing different types of pain, bringing us closer to development of mechanism-based diagnoses and treatments for the chronic pain patient.

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Section: Neuroimaging As a Tool For Assessing Drug-induced Analgesia mentioning

confidence: 99%

Neuroimaging as a Tool for Pain Diagnosis and Analgesic Development

Wartolowska

Tracey

2009

Neurotherapeutics

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“…Our results suggest that DBS gives analgesia most consistently to patients with pain after amputation, either phantom or stump, cranial and facial pain, including anesthesia dolorosa, and plexopathies. Our experience of pain after stroke reveals greatest efficacy for stroke patients complaining of burning hyperaesthesia [48,79]. Therefore, the stroke case series illustrates how important patient selection is to outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Other pain etiologies for which we and others have obtained good outcomes using DBS are stroke [48,79]; cephalalgia, including postherpetic trigeminal neuralgia and anesthesia dolorosa [47,80]; multiple sclerosis [43]; genital pain; and malignancy [73,81]. We find little merit in the administration of opiates or naloxone to determine suitability for DBS, although a historical literature exists [46].…”

Section: Patient Selectionmentioning

confidence: 96%

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Neuropathic Pain and Deep Brain Stimulation

Pereira

Aziz

2014

Neurotherapeutics

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Deep brain stimulation (DBS) is a neurosurgical intervention the efficacy, safety, and utility of which are established in the treatment of Parkinson's disease. For the treatment of chronic, neuropathic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated with current standards of neuroimaging and stimulator technology over the last decade . We summarize the history, science, selection, assessment, surgery, programming, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and latterly rostral anterior cingulate cortex (Cg24) in 113 patients treated at 2 centers (John Radcliffe, Oxford, UK, and Hospital de São João, Porto, Portugal) over 13 years. Several experienced centers continue DBS for chronic pain, with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS under general anesthesia considered for whole or hemibody pain, or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.

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“…Stimulation of the PVG and VC for central poststroke pain (CPSP), however, has failure rates ranging from 33% to 82%. 4,8,9 These poor results suggest that alternative targets should be explored.…”

Section: T He Efficacy Of Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

Mallory

Abulseoud

Hwang

et al. 2012

Mayo Clinic Proceedings

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Although deep brain stimulation (DBS) has been found to be efficacious for some chronic pain syndromes, its usefulness in patients with central poststroke pain (CPSP) has been disappointing. The most common DBS targets for pain are the periventricular gray region (PVG) and the ventralis caudalis of the thalamus. Despite the limited success of DBS for CPSP, few alternative targets have been explored. The nucleus accumbens (NAC), a limbic structure within the ventral striatum that is involved in reward and pain processing, has emerged as an effective target for psychiatric disease. There is also evidence that it may be an effective target for pain. We describe a 72-year-old woman with a large right hemisphere infarct who subsequently experienced refractory left hemibody pain. She underwent placement of 3 electrodes in the right PVG, ventralis caudalis of the thalamus, and NAC. Individual stimulation of the NAC and PVG provided substantial improvement in pain rating. The patient underwent implantation of permanent electrodes in both targets, and combined stimulation has provided sustained pain relief at nearly 1 year after the procedure. These results suggest that the NAC may be an effective DBS target for CPSP.

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Deep brain stimulation for the alleviation of post-stroke neuropathic pain

Cited by 168 publications

References 11 publications

Neuroimaging as a Tool for Pain Diagnosis and Analgesic Development

Neuroimaging as a Tool for Pain Diagnosis and Analgesic Development

Neuropathic Pain and Deep Brain Stimulation

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

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