title: Deep brain stimulation for chronic pain.
abstract: Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex. However, this technique remains "off label" in the USA as it does not have Federal Drug Administration approval. Consequently, only a small number of surgeons report DBS for pain using current technology and techniques and few regions approve it. Randomised, blinded and controlled clinical trials that may use novel trial methodologies are desirable to evaluate the efficacy of DBS in patients who are refractory to other therapies. New imaging techniques, including tractography, may help optimise electrode placement and clinical outcome.
authors.affiliation: Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. Electronic address: sandra.boccard@ndcn.ox.ac.uk.
authors.forename: Sandra G J
authors.initials: SG
authors.lastname: Boccard
authors.affiliation: Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
authors.forename: Erlick A C
authors.initials: EA
authors.lastname: Pereira
authors.affiliation: Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D059350:Chronic Pain / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods; D004567:Electrodes, Implanted; D006179:Gyrus Cinguli; D006801:Humans; D019635:Neurosurgical Procedures; D010148:Intractable Pain / Q000628:therapy*; D010487:Periaqueductal Gray; D013788:Thalamus; D016896:Treatment Outcome
keywords: Anterior cingulate cortex; Chronic pain; Deep brain stimulation; Periaqueductal grey; Periventricular grey; Sensory thalamus