title: Deep brain stimulation of the dorsal anterior cingulate cortex for the treatment of chronic neuropathic pain.
abstract: Chronic neuropathic pain is estimated to affect 3%-4.5% of the worldwide population. It is associated with significant loss of productive time, withdrawal from the workforce, development of mood disorders such as depression and anxiety, and disruption of family and social life. Current medical therapeutics often fail to adequately treat chronic neuropathic pain. Deep brain stimulation (DBS) targeting subcortical structures such as the periaqueductal gray, the ventral posterior lateral and medial thalamic nuclei, and the internal capsule has been investigated for the relief of refractory neuropathic pain over the past 3 decades. Recent work has identified the dorsal anterior cingulate cortex (dACC) as a new potential neuromodulation target given its central role in cognitive and affective processing. In this review, the authors briefly discuss the history of DBS for chronic neuropathic pain in the United States and present evidence supporting dACC DBS for this indication. They review existent literature on dACC DBS and summarize important findings from imaging and neurophysiological studies supporting a central role for the dACC in the processing of chronic neuropathic pain. The available neurophysiological and empirical clinical evidence suggests that dACC DBS is a viable therapeutic option for the treatment of chronic neuropathic pain and warrants further investigation.
authors.affiliation: 1Columbia University College of Physicians and Surgeons and.|2Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Russo
authors.affiliation: 2Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Sheth
mesh_terms: D002908:Chronic Disease; D046690:Deep Brain Stimulation / Q000379:methods*; D006179:Gyrus Cinguli / Q000502:physiology*; D006801:Humans; D009434:Neural Pathways / Q000502:physiology; D009437:Neuralgia / Q000628:therapy*
keywords: ACC; ACC = anterior cingulate cortex; DBS = deep brain stimulation; DTI = diffusion tensor imaging; IASP = International Association for the Study of Pain; IC = internal capsule; LTP = long-term potentiation; MRS = MR spectroscopy; PAG = periaqueductal gray; PVG = periventricular gray; VAS = visual analog scale; VPLA/PM = ventral posterior lateral and medial thalamic nuclei; anterior cingulate cortex; chronic pain; dACC; dACC = dorsal ACC; deep brain stimulation; fMRI = functional MRI; neuropathic pain