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Seminars in Neurosurgery 2004; 15(2/03): 183-193
DOI: 10.1055/s-2004-835707
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Deep Brain Stimulation for Chronic Pain

Louis A. Whitworth1 , Julius Fernández2 , Claudio A. Feler2
  • 1Department of Neurosurgery, Southwestern Medical School, University of Texas, Southwestern, Dallas, Texas
  • 2Private Practice, Memphis, Tennessee
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Publication History

Publication Date:
25 October 2004 (online)

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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.

KEYWORDS

Pain - stimulation - thalamus

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Claudio A FelerM.D. 

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