Deep Brain Stimulation for Chronic Pain

The control of chronic intractable pain has been a challenge to neurosurgeons for decades. Over the last 30 years there has been a shift in treatment paradigms from ablation to neuroaugmentation therapies. Surgical ablative treatments have in common the risk of motor system deficits and delayed deafferentation pain. In recent years, electrical stimulation and intrathecal drug delivery have become the favored interventional treatments for chronic benign pain syndromes. The use of electrical stimulation on the human brain to modulate pain dates back to the 1950s. Paramount to obtaining a good outcome with deep brain stimulation (DBS) is the proper selection of a patient and a correct target. In contemporary times, selection of patients for DBS procedures should be limited to those who experience neuropathic pain syndromes and more specifically complain of constant, steady burning or aching pain. These patients must first be considered for stimulation at other sites, such as spinal cord, nerve root, or peripheral nerve. Patients who have had trials with one of these other targets may have failed to respond for a variety of reasons. If the failure has been due to an inability to produce an overlap of paresthesia on the pain segment, the patient may be considered a candidate for DBS. Other reasons for failure of the previously attempted targets are likely to predict failure of DBS as well.

Pain - stimulation - thalamus

REFERENCES

• 1 Pool J L, Clark W D, Hudson P, Lumbardo M. Pyschosurgery. In: Fields WS [and others] Hypothalamic-Hypophyseal Interrelationships. Springfield, IL; Charles C Thomas 1956: 148-156
• 2 Heath R G, Mickle W A. Evaluation of 7 years’ experience with depth electrode studies in human patients. In: Ramey ER, O’Doherty DS Electrical Studies in Anesthetized Brain. New York; Harper & Row 1960: 214-217
• 3 Melzack R, Wall P D. Pain mechanisms: a new theory.  Science. 1965;  150 971-978
• 4 Reynolds D V. Surgery in the rat during electrical analgesia induced by focal brain stimulation.  Science. 1969;  164 444-445
• 5 Richardson D E, Akil H. Chronic self-administrated brain stimulation for the relief of intractable pain. Abstracts of the 7th Annual Meeting of the Neuro-electric Society 1974
• 6 Hosobuchi Y, Adams J E, Linchitz R. Pain relief by electrical stimulation of the central gray matter in humans and its reversal by naloxone.  Science. 1977;  197 183-186
• 7 Mazars G J. Intermittent stimulation of nucleus ventralis posterolateralis for intractable pain.  Surg Neurol. 1975;  4 93-95
• 8 White J C, Sweet W H. Pain and the Neurosurgeon: A Forty-Year Experience. Springfield, IL; Charles C Thomas 1969
• 9 Katayama Y, Watkins L R, Becker D P. Evidence for involvement of cholinoceptive cells of the parabrachial region in environmentally induced nociceptive suppression in the cat.  Brain Res. 1984;  299 348-353
• 10 Young R F, Tronnier V M, Rinaldi P C. Chronic stimulation of the Kölliker-Fuse nucleus region for the relief of intractable pain in humans.  J Neurosurg. 1992;  76 979-985
• 11 Andy O. Parafascicular-center median nuclei stimulation for intractable pain and dyskinesia (painful-dyskinesia).  Appl Neurophysiol. 1980;  43 133-144
• 12 Tsubokawa T, Katayama Y, Yumanoto T. Chronic motor cortex stimulation for the treatment of central pain.  Acta Neurochir Suppl (Wien). 1991;  52 137-139
• 13 Mayer D J, Wolfe T L, Akil H et al.. Analgesia from electrical stimulation in the brainstem of the rat.  Science. 1971;  174 1351-1354
• 14 Lewis V A, Gebhart G F. Morphine-induced and stimulation-produced analgesias at coincident periaqueductal central gray loci: evaluation of analgesia congruence, tolerance, and cross-tolerance.  Exp Neurol. 1977;  57 934-955
• 15 Akil H, Richardson D E, Barcus J D, Li C H. Appearance of beta-endorphin-like immunoreactivity in human ventricular cerebrospinal fluid upon analgesic electrical stimulation.  Proc Natl Acad Sci USA. 1978;  75 5170-5172
• 16 Mayer D J, Liebeskind J C. Pain reduction by focal electrical stimulation of the brain: an anatomical and behavior analysis.  Brain Res. 1974;  68 73-93
• 17 Basbaum A I, Fields H L. Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry.  Annu Rev Neurosci. 1984;  7 309-338
• 18 Young R F, Chambi V I. Pain relief by electrical stimulation of the periaqueductal and periventricular gray matter: evidence for a non-opioid mechanism.  J Neurosurg. 1987;  66 364-371
• 19 Fessler R G, Brown F D, Rachlin J R et al.. Elevated beta-endorphin in cerebrospinal fluid after electrical stimulation; artifact or contrast infusion?.  Science. 1984;  224 1017-1019
• 20 Murfin R, Bennett G L, Mayer D J. The effects of dorsolateral spinal cord lesion on analgesia from morphine microinjected into the periaqueductal gray matter (PAG) of the rat.  Soc Neurosci (Abst). 1976;  2 946
• 21 Carstens E, Guinan M J, MacKinnon J D. Naloxone does not consistently affect inhibition of spinal nociceptive transmission produced by medial diencephalic stimulation in the cat.  Neurosci Lett. 1983;  42 71-76
• 22 Basbaum A I, Fields H L. The origin of descending pathways in the dorsolateral funiculus of the spinal cord of the cat and rat: further studies on the anatomy of pain modulation.  J Comp Neurol. 1979;  187 513-532
• 23 Hosobuchi Y, Rossier J, Bloom F E, Guillemin R. Stimulation of human periaqueductal gray for pain relief increases immunoreactive beta-endorphin in ventricular fluid.  Science. 1979;  203 279-281
• 24 Krout K E, Jansen A S, Loewy A D. Periaqueductal gray matter projections to the parabrachial nucleus in rat.  J Comp Neurol. 1998;  401 429-436
• 25 Odeh F, Antal M. The projections of the midbrain periaqueductal gray in the pos and medulla oblongata in rats.  Eur J Neurosci. 2001;  14 1275-1286
• 26 Rees H, Ternezi M G, Roberts M H. Anterior pretectal nucleus facilitation of superficial dorsal horn neurons and modulation of deafferentation pain in the rat.  J Physiol. 1995;  489 159-169
• 27 Blomqvist A, Hermanson O, Ericson H, Larhammar D. Activation of a bulbospinal opioidergic projections by pain stimuli in the awake rat.  Neuroreport. 1994;  5 461-464
• 28 Hermann D M, Luppi P H, Peyron C, Hinckel P, Jouvet M. Afferent projections to the rat nuclei raphe magnus, raphe pallidus and reticularis gigantocellularis pars alpha demonstrated by iontophoretic application of choleratoxin (subunit b).  J Chem Neuroanat. 1997;  13 1-21
• 29 Bajic D, Proudfit H K. Projections of neurons in the periaqueductal gray to pontine and medullar catecholamine cell group involved in the modulation of nociception.  J Comp Neurol. 1999;  405 359-379
• 30 Harris J A. Using c-fos as a neural marker for pain.  Brain Res Bull. 1998;  45 1-8
• 31 Sandkuhler J. The organization and function of endogenous antinociceptive systems.  Prog Neurobiol. 1996;  50 49-81
• 32 Mountcastle V B, Hennenman E. The representation of tactile sensibility in the thalamus of the monkey.  J Comp Neurol. 1952;  97 409-440
• 33 Poggio G F, Mountcastle V B. The functional properties of ventrobasal thalamic neurons studied in unanesthetized monkeys.  J Neurophysiol. 1963;  26 775-806
• 34 Tasker R R, Emmers R. A double somatotopic representation in the human thalamus. Its implication in localization during thalamotomy for Parkinson’s disease. In: Gillingham FJ, Donaldson T Third Symposium on Parkinson’s Disease. Edinburgh; Livingstone 1969: 94-100
• 35 Gerhart K D, Yezierski R P, Fang Z R et al.. Inhibition of primate spinothalamic tract neurons by stimulation in ventral posterior lateral thalamic nucleus: possible mechanisms.  J Neurophysiol. 1983;  49 406-423
• 36 Tsubokawa T, Yamamoto T, Katayama Y et al.. Clinical results and physiologic basis of thalamic relay nucleus stimulation for relief of intractable pain with morphine tolerance.  Appl Neurophysiol. 1982;  45 143-155
• 37 Giesler G J, Yezierski R P, Gerhart K D et al.. Spinothalamic tract neurons that project to medial and/or lateral thalamic nuclei: evidence for a physiologically novel population of spinal cord neurons.  J Neurophysiol. 1981;  46 1285-1308
• 38 Daniel M S, Hutcherson M S, Hunter S. Psychological factors and outcome of electrode implantation for chronic pain.  Neurosurgery. 1985;  17 773-777
• 39 Nelson D. Psychological selection criteria for implantable spinal cord stimulators.  Pain Forum. 1996;  5 93-103
• 40 Long C J. The relationship between surgical outcome and MMPI profiles in chronic pain patients.  J Clin Psychol. 1981;  37 744-749
• 41 Richardson D E, Akil H. Pain reduction by electrical brain stimulation in man: acute administration in periaqueductal and periventricular sites.  J Neurosurg. 1977;  47 178-183
• 42 Kupers R, Gybels J. Electrical stimulation of the ventral posterolateral thalamic nucleus (VPL) reduces mechanical allodynia in a rat model of neuropathic pain.  Neurosci Lett. 1993;  150 95-98
• 43 Hosobuchi Y. Combined electrical stimulation of the periaqueductal gray matter and sensory thalamus.  Appl Neurophysiol. 1983;  46 112-115
• 44 Hosobuchi Y. Subcortical electrical stimulation for control of intractable pain in humans.  J Neurosurg. 1986;  64 543-553
• 45 Mundinger F, Salomao J F. Deep brain stimulation in mesencephalic lemniscus medialis for chronic pain.  Acta Neurochir Suppl (Wien). 1980;  30 245-258
• 46 Schvarcz J R. Long-term results of stimulation of the septal area for relief of neurogenic pain.  Acta Neurochir Suppl (Wien). 1993;  58 154-155
• 47 Lefaucheur J P, Drouot X, Keravel Y et al.. Pain relief induced by repetitive transcranial magnetic stimulation precentral cortex.  Neuroreport. 2001;  12 2963-2965
• 48 Young R F, Rinaldi P C. Brain stimulation in pain. In: Levy RM, North RB The Neurosurgery of Chronic Pain. New York; Springer-Verlag 1995: 241-256
• 49 Schaltenbrand G, Wahren W. Atlas for Stereotaxy of the Human Brain. Stuttgart; Thieme 1977
• 50 Turnbull I M, Shulman R, Woodhurst W. Thalamic stimulation for neuropathic pain.  J Neurosurg. 1980;  52 486-493
• 51 Hirayama T, Dostrovsky J O, Goreki J et al.. Recording of abnormal activity in patients with deafferentation and central pain.  Stereotact Funct Neurosurg. 1989;  52 120-126
• 52 Lenz F A, Dostrovsky J O, Tasker R R. Single-unit analysis of human ventral thalamic nuclear group: somatosensory responses.  J Neurophysiol. 1988;  59 299-316
• 53 Heath R G, Mickle W A. Evaluation of seven years’ experience with depth electrode studies in human patients. In: Ramey ER, O’Doherty DS Electrical Studies on the Unanesthetized Brain. New York; Paul B Hoeber 1960: 214-247
• 54 Kumar K, Toth C, Nath R. Deep brain stimulation for intractable pain: a 15-year experience.  Neurosurgery. 1997;  40 736-747
• 55 Levy M R, Adams J E. Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature.  Neurosurgery. 1987;  21 885-892
• 59 Parrent A G, Lozano A M, Dostrovsky J O, Tasker R R. Central pain in the absence of functional sensory thalamus.  Stereotact Funct Neurosurg. 1992;  59 9-14
• 56 Young R F, Brechner T. Electrical stimulation of the brain for relief of intractable pain due to cancer.  Cancer. 1986;  57 1266-1272
• 57 Meglio M. Evaluation and management of central and peripheral deafferentation pain. In: Gildenberg PL, Tasker RR Stereotactic and Functional Neurosurgery. New York; McGraw-Hill 1998: 631-1635
• 58 Gonzales G R, Herskovitz S, Rosenblum M et al.. Central pain from cerebral abscess: thalamic syndrome in AIDS patients with toxoplasmosis.  Neurology. 1992;  42 1107-1109
• 60 Levin A B, Ramirez L F, Katz J. The use of stereotactic chemical hypophysectomy in the treatment of thalamic pain syndrome.  J Neurosurg. 1983;  59 1002-1006
• 61 Gybels J M, Kupers R C. Brain stimulation in the management of persistent pain. In: Schmidek HH Operative Neurosurgical Techniques. Philadelphia; WB Saunders 2000: 1639-1651
• 62 Siegfried J. Therapeutical neurostimulation: indication reconsidered.  Acta Neurochir Suppl (Wien). 1991;  52 112-117
• 63 Melzack R, Loeser J D. Phantom body pain in paraplegics: evidence for “central pattern generating mechanism” for pain.  Pain. 1978;  4 195-210
• 64 Mundinger F, Neumuller H. Programmed transcutaneous and central stimulation for control of phantom limb pain and causalgia; a new method for treatment. In: Siegfried J, Zimmerman M Phantom and Stump Pain. New York; Springer 1981: 164-178
• 65 Mazars G, Merienne L, Cioloca C. Comparative study of electrical stimulation of posterior thalamic nuclei, periaqueductal gray, and other midline structures in man.  Adv Pain Res Ther. 1979;  3 541-546
• 66 Lazorthes Y. European study on deep brain stimulation. Resume Third European Workshop on Electrical Neurostimulation. Paris; Medtronic 1979
• 67 Roux F E, Ibarrola D, Lazorthes Y et al.. Virtual movements activate primary sensorimotor area in amputee: report of three cases.  Neurosurgery. 2001;  49 736-741
• 68 Tasker R R, DeCarvalho G TC, Dolan E J. Intractable pan of spinal cord origin: clinical features and implication for surgery.  J Neurosurg. 1992;  77 373-378