Deep Brain Stimulation in Refractory Chronic Pain

Jeraq, Mohammed; Bayoumi, Ahmed M.; Kasper, Ekkehard M.; Tierney, Travis S.

doi:10.1093/med/9780199377374.003.0016

Cited by 1 publication

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“…Although not yet approved by the FDA, evidence for the use of DBS to treat chronic pain has been accumulating in the literature for many years (54). The periventricular gray region and somatosensory the thalamus are the most frequent targets for treating nociceptive pain and neuropathic pain respectively (55). A study of patients with chronic neuropathic pain demonstrated that DBS could have long-term efficacy for certain etiologies such as amputation (56) and stroke (57).…”

Section: Chronic Painmentioning

confidence: 99%

Deep brain stimulation foundations and future trends

2018

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Deep brain stimulation (DBS) has emerged as a revolutionary treatment option for essential tremor (ET), Parkinson's disease (PD), idiopathic dystonia, and severe obsessive-compulsive disorder (OCD). This article reviews the historical foundations of DBS including basal ganglia pathophysiological models, classic principles of electrical stimulation, technical components of the DBS system, treatment risks, and future directions for DBS. Chronic high frequency stimulation induces a number of functional changes from fast physiological to slower metabolic effects and ultimately leads to structural reorganization of the brain, so-called neuroplasticity. Examples of each of these fast, slow, and long-term changes are given in the context of Parkinson's disease where these mechanisms have perhaps been the most intensely investigated. In particular, details of striatal dopamine release, expression of trophic factors, and a possible neuroprotective mechanism of DBS are highlighted. We close with a brief discussion of technical and clinical considerations for improvement. Deep brain stimulation will continue to offer a reversible and safe therapeutic option for a host of neurological conditions and remains one of the best windows into human brain physiology.

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