Electrical stimulation of the brain in treatment of chronic pain

Abstract

Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule. Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

“…The authors reviewed five case series and found that just 36 out of 334 patients benefitted from implanted DBS. 28,33,47,50,51 It should be noted that the nature or characteristics of the neuropathic pain in these patients was not described. In four studies with a total of 266 implantations, 80 major adverse events were reported that required 63 new surgical procedures.…”

“…In the following decades, electrical stimulation of the thalamus, internal capsule, and periaqueductal gray matter or periventricular gray matter (PVG) became commonly used procedures to treat chronic refractory pain. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Within the last decade, the number of patients with chronic pain treated with DBS, as well as the number of the published studies, have progressively decreased, mainly because of the lack of solid scientific evidence of DBS safety and efficacy and the development of less invasive alternatives to manage nociceptive pain. Although DBS produced impressive results in a subset of patients, the results were highly variable, and appropriate patient selection seems to be very important.…”

The Periaqueductal Gray: From Longitudinal columns to defensive behaviour

“…In humans, stimulation of the PAG was originally applied for pain relief , Young, et al, 1985. Some studies also reported other findings after PAG stimulation.…”

Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Chronic Intractable Neuropathic Pain

“…DBS for chronic pain has been undertaken for over half a century [15,16,17,18,19,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41], its use preceding the ‘gate theory' by a decade. However, multiple reports had conveyed an overall impression regarding DBS for pain that had led most neurosurgeons to abandon the technique [15,41].…”