Abstract
Chronic intractable pain is debilitating for those touched, affecting 5% of the population. Deep brain stimulation (DBS) has fallen out of favour as the centrally implantable neurostimulation of choice for chronic pain since the 1970–1980s, with some neurosurgeons favouring motor cortex stimulation as the ‘last chance saloon’. This article reviews the available data and professional opinion of the current state of DBS as a treatment for chronic pain, placing it in the context of other neuromodulation therapies. We suggest DBS, with its newer target, namely anterior cingulate cortex (ACC), should not be blacklisted on the basis of a lack of good quality study data, which often fails to capture the merits of the treatment.
Highlights
Chronic pain is an important health issue drastically altering the lives of those it affects; it is estimated that 5% of the population suffer chronic pain despite pharmacotherapy [1]
The results show no significant difference in pain-related-disability as indexed by the arbitrarily set ‘greater than 50%’ improvement on the pain disability index (11% deep brain stimulation (DBS) on vs. 12% DBS off; odds ratio = 1.05, 95% CI 0.96–1.15 p = 0.270)
A series of cases from the Oxford group have since replicated these benefits in case series ranging from n-of-1 to n-of-24, demonstrating that bilateral anterior cingulate cortex (ACC) stimulation is efficacious for a variety of pain aetiologies including failed back surgery syndrome (FBSS), post-stroke, spinal cord injury, brachial plexus lesions, and head injury, but that it delivers long term control over a period of years [63,123,124]
Summary
Chronic pain is an important health issue drastically altering the lives of those it affects; it is estimated that 5% of the population suffer chronic pain despite pharmacotherapy [1]. It has been tempting to categorize chronic pain by its cause, and into categories such as ‘nociceptive vs deafferentation’ or ‘peripheral vs central’. The utility of this is questionable, given that the development and maintenance of pain is thought to involve neuronal plasticity encompassing centrally mediated changes, as suggested by both functional neuroimaging and electrophysiological data [8,9,10,11,12,13]. The efficacious results of deep brain stimulation (DBS) in spinal cord-related patients, for example, those with failed back surgery syndrome (FBSS), are consistent with this theory, suggesting a centrally mediated component to this initially peripheral injury, which is able to respond favourably to thalamic or anterior cingulate cortex (ACC) stimulation [14]. Brain Sci. 2018, 8, 158; doi:10.3390/brainsci8080158 www.mdpi.com/journal/brainsci
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