Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex. However, this technique remains "off label" in the USA as it does not have Federal Drug Administration approval. Consequently, only a small number of surgeons report DBS for pain using current technology and techniques and few regions approve it. Randomised, blinded and controlled clinical trials that may use novel trial methodologies are desirable to evaluate the efficacy of DBS in patients who are refractory to other therapies. New imaging techniques, including tractography, may help optimise electrode placement and clinical outcome.

Original publication

DOI

10.1016/j.jocn.2015.04.005

Type

Journal article

Journal

J Clin Neurosci

Publication Date

10/2015

Volume

22

Pages

1537 - 1543

Keywords

Anterior cingulate cortex, Chronic pain, Deep brain stimulation, Periaqueductal grey, Periventricular grey, Sensory thalamus, Adult, Analgesia, Chronic Pain, Deep Brain Stimulation, Electrodes, Implanted, Gyrus Cinguli, Humans, Neurosurgical Procedures, Pain, Intractable, Periaqueductal Gray, Thalamus, Treatment Outcome