title: Deep brain stimulation for chronic pain: intracranial targets, clinical outcomes, and trial design considerations.
abstract: For over half a century, neurosurgeons have attempted to treat pain from a diversity of causes using acute and chronic intracranial stimulation. Targets of stimulation have included the sensory thalamus, periventricular and periaqueductal gray, the septum, the internal capsule, the motor cortex, posterior hypothalamus, and more recently, the anterior cingulate cortex. The current work focuses on presenting and evaluating the evidence for the efficacy of these targets in a historical context while also highlighting the major challenges to having a double-blind placebo-controlled clinical trial. Considerations for pain research in general and use of intracranial targets specifically are included.
authors.affiliation: MD/PhD Program, School of Medicine, Emory University, Suite 375-B, 1648 Pierce Drive, Atlanta, GA 30322, USA.
authors.forename: Orion Paul
authors.initials: OP
authors.lastname: Keifer
authors.affiliation: Department of Neurosurgery, Emory University, 1365-B Clifton Road Northeast, Suite 2200, Atlanta, GA 30322, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Riley
authors.affiliation: Department of Neurosurgery, Emory University, 1365-B Clifton Road Northeast, Suite 2200, Atlanta, GA 30322, USA. Electronic address: nboulis@emory.edu.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Boulis
mesh_terms: D001921:Brain / Q000503:physiopathology / Q000601:surgery; D059350:Chronic Pain / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome
keywords: Anterior cingulate cortex; Chronic pain; Clinical trial design; Deep brain stimulation; Intracranial stimulation; Periventricular and periaqueductal gray; Sensory thalamus; Surgery