Abstract

Review Article

The continued relevance of Deep Brain Stimulation for chronic pain

Sarah Marie Farrell and Tipu Aziz*

Published: 27 July, 2021 | Volume 6 - Issue 1 | Pages: 009-014

For the millions of patients experiencing chronic pain despite pharmacotherapy, deep brain stimulation (DBS) provides a beacon of hope. Over the past decade the field has shifted away from DBS towards other forms of neuromodulation, particularly spinal cord stimulation (SCS). DBS for pain is still performed, albeit off-label in US and UK, and experiences variable success rates.

SCS is an extremely useful tool for the modulation of pain but is limited in its application to specific pain aetiologies. We advocate use of DBS for pain, for patients for whom pharmacology has failed and for whom spinal cord stimulation is inadequate. DBS for chronic pain is at risk of premature neglect. Here we outline how this has come to pass, and in the process argue for the untapped potential for this procedure.

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001034 Cite this Article Read Full Article PDF

References

  1. Fayaz A, Croft P, Langford RM, Donaldson LJ Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016; 6: e010364. PubMed: https://pubmed.ncbi.nlm.nih.gov/27324708/
  2. Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018; 67: 1001-1006. PubMed: https://pubmed.ncbi.nlm.nih.gov/30212442/
  3. Johnson B, Hayes LD, Brown K, Hoo EC, Ethier KA, et al. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors--United States, 2005-2013. MMWR Suppl. 2018; 63: 3-27. PubMed: https://pubmed.ncbi.nlm.nih.gov/25356673/
  4. Pizzo PA, Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Press, Washington (DC). 2011. PubMed: https://pubmed.ncbi.nlm.nih.gov/22553896/
  5. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C, et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008; 136: 380-387. PubMed: https://pubmed.ncbi.nlm.nih.gov/17888574/
  6. Stafford K, Gomes AB, Shen J, Yoburn BC. Mu-Opioid receptor downregulation contributes to opioid tolerance in vivo. Pharmacol Biochem Behav. 2001; 69: 233-237. PubMed: https://pubmed.ncbi.nlm.nih.gov/11420091/
  7. Gao F, Chu H, Li J, Yang M. Liangjie DU, et al. Repetitive transcranial magnetic stimulation for pain after spinal cord injury: a systematic review and meta-analysis. J Neurosurg Sci. 2017; 61: 514-522. PubMed: https://pubmed.ncbi.nlm.nih.gov/27603408/
  8. Hamid P, Malik BH, Hussain ML. Noninvasive Transcranial Magnetic Stimulation (TMS) in Chronic Refractory Pain: A Systematic Review. Cureus. 2019; 11: e6019. PubMed: https://pubmed.ncbi.nlm.nih.gov/31824787/
  9. Lefaucher JP, Aleman A, Baeken C, Benninger DH, Brunelin J, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). 2020; 131: 474-528. PubMed: https://pubmed.ncbi.nlm.nih.gov/31901449/
  10. Ayache S, Benninger D. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation. et al. Clin Neurophysiol. 2017; 128: 56-92. PubMed: https://pubmed.ncbi.nlm.nih.gov/27866120/
  11. Alwardat M, Pisani A, Etoom M, Carpenedo R, Chinè E, et al. Is transcranial direct current stimulation (tDCS) effective for chronic low back pain? A systematic review and meta-analysis. J Neural Transm (Vienna). 2020; 127: 1257-1270. PubMed: https://pubmed.ncbi.nlm.nih.gov/32647923/
  12. Pinto CB, Teixeira Costa B, Duarte D, Fregni F. Transcranial Direct Current Stimulation as a Therapeutic Tool for Chronic Pain. J ECT. 2018; 34: e36-e50. PubMed: https://pubmed.ncbi.nlm.nih.gov/29952860/
  13. Cho JH, Lee JH, Song KS, Hong JY, Joo YS, et al. Treatment Outcomes for Patients with Failed Back Surgery. Pain Physician. 2017; 20: E29-E43. PubMed: https://pubmed.ncbi.nlm.nih.gov/28072795/
  14. Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res. 2016; 979-987. PubMed: https://pubmed.ncbi.nlm.nih.gov/27853391/
  15. Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: a systematic review and analysis of prognostic factors. Spine (Phila Pa 1976). 2005; 30: 152-160. PubMed: https://pubmed.ncbi.nlm.nih.gov/15626996/
  16. Tiede J, Brown L, Gekht G, Vallejo R. et al. Novel spinal cord stimulation parameters in patients with predominant back pain. Neuromodulation. 2013; 16: 370-375. PubMed: https://pubmed.ncbi.nlm.nih.gov/23433237/
  17. Deer TR, Levy RM, Kramer J, Poree L, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 2017; 158: 669-681. PubMed: https://pubmed.ncbi.nlm.nih.gov/28030470/
  18. Katayama Y, Yamamoto T, Kobayashi K, Kasai M, et al. Motor cortex stimulation for phantom limb pain: comprehensive therapy with spinal cord and thalamic stimulation. Stereotact Funct Neurosurg. 2001a; 77: 159-162. PubMed: https://pubmed.ncbi.nlm.nih.gov/12378068/
  19. Katayama Y, Yamamoto T, Kobayashi K, Kasai M, et al. Motor cortex stimulation for post-stroke pain: comparison of spinal cord and thalamic stimulation. Stereotact Funct Neurosurg. 2001b; 77: 183-186. PubMed: https://pubmed.ncbi.nlm.nih.gov/12378074/
  20. Adams JE. Naloxone reversal of analgesia produced by brain stimulation in the human. Pain. 1976; 2: 161-166. PubMed: https://pubmed.ncbi.nlm.nih.gov/800249/
  21. Nowacki A, Moir L, Owen SL, Fitzgerald JJ, et al. Deep brain stimulation of chronic cluster headaches: Posterior hypothalamus, ventral tegmentum and beyond. Cephalalgia. 2019; 39: 1111-1120. PubMed: https://pubmed.ncbi.nlm.nih.gov/30897941/
  22. Bergeron D, Obaid S, Fournier-Gosselin MP, Bouthillier A. et al. Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A theoretical Framework. Brain Sci. 2021; 11: 639.
  23. Heath RG. Psychiatry. Annu Rev Med. 1954; 223-236. PubMed: https://pubmed.ncbi.nlm.nih.gov/13181376/
  24. Gol A. Relief of pain by electrical stimulation of the septal area. J Neurol Sci. 1967; 5: 115-120. PubMed: https://pubmed.ncbi.nlm.nih.gov/6061755/
  25. Mazars G, Mérienne L, Ciolocca C. Intermittent analgesic thalamic stimulation. Preliminary note. Rev Neurol (Paris). 1973; 128: 273-279. PubMed: https://pubmed.ncbi.nlm.nih.gov/4774913/
  26. Pool JL. Psychosurgery in older people. J Am Geriatr Soc. 1954; 2: 456-466. PubMed: https://pubmed.ncbi.nlm.nih.gov/13183737/
  27. Olds J, Milner P. Positive reinforcement produced by electrical stimulation of septal area and other regions of rat brain. J Comp Physiol Psychol. 1954; 47: 419-427. PubMed: https://pubmed.ncbi.nlm.nih.gov/13233369/
  28. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965; 150: 971-979. PubMed: https://pubmed.ncbi.nlm.nih.gov/5320816/
  29. Hosobuchi Y, Adams JE, Rutkin B. Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Arch Neurol. 1973; 29: 158-161. PubMed: https://pubmed.ncbi.nlm.nih.gov/4591720/
  30. Hosobuchi Y, Adams JE, Linchitz R. Pain relief by electrical stimulation of the central gray matter in humans and its reversal by naloxone. Science. 199; 197: 183-186. PubMed: https://pubmed.ncbi.nlm.nih.gov/301658/
  31. Nandi D, Smith H, Owen S, Joint C, et al. Peri-ventricular grey stimulation versus motor cortex stimulation for post stroke neuropathic pain. J Clin Neurosci. 2002; 9: 557-561. PubMed: https://pubmed.ncbi.nlm.nih.gov/12383415/
  32. Boccard SG, Fitzgerald JJ, Pereira EA, Moir L, et al. Targeting the affective component of chronic pain: a case series of deep brain stimulation of the anterior cingulate cortex. Neurosurgery. 2014; 74: 628-635. PubMed: https://pubmed.ncbi.nlm.nih.gov/24739362/
  33. Boccard SG, Pereira EA, Moir L, Aziz TZ, et al. Long-term outcomes of deep brain stimulation for neuropathic pain. Neurosurgery. 2013; 72: 221-230. PubMed: https://pubmed.ncbi.nlm.nih.gov/23149975/
  34. Boccard SG. Prangnell SJ, Pycroft L, Cheeran B. et al. Long-Term Results of Deep Brain Stimulation of the Anterior Cingulate Cortex for Neuropathic Pain. World Neurosurg, 2017; 625-637. PubMed: https://pubmed.ncbi.nlm.nih.gov/28710048/
  35. Spooner J, Yu H, Kao C, Sillay K, et al. Neuromodulation of the cingulum for neuropathic pain after spinal cord injury. Case report. J Neurosurg. 2007; 107: 169-172. PubMed: https://pubmed.ncbi.nlm.nih.gov/17639889/
  36. Farrell SM, Green A, Aziz T. The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation. Brain Sci. 2018; 8: 158. PubMed: https://pubmed.ncbi.nlm.nih.gov/30127290/
  37. Marchand S, Kupers RC, Bushnell MC, Duncan GH. Analgesic and placebo effects of thalamic stimulation. Pain. 2003; 105: 3481-488. PubMed: https://pubmed.ncbi.nlm.nih.gov/14527708/
  38. Coffey RJ. Deep brain stimulation for chronic pain: results of two multicenter trials and a structured review. Pain Med. 2001; 2: 183-192. PubMed: https://pubmed.ncbi.nlm.nih.gov/15102250/
  39. Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg. 2009; 110: 251-256. PubMed: https://pubmed.ncbi.nlm.nih.gov/18991496/
  40. Boccard SG, Pereira EA, Moir L, Van Hartevelt TJ, et al. Deep brain stimulation of the anterior cingulate cortex: targeting the affective component of chronic pain. Neuroreport. 2014; 25: 83-88. PubMed: https://pubmed.ncbi.nlm.nih.gov/24100411/
  41. Frizon LA, Yamamoto EA, Nagel SJ, Simonson MT, Hogue O, et al. Deep Brain Stimulation for Pain in the Modern Era: A Systematic Review. Neurosurgery. 2020; 86: 191-202. PubMed: https://pubmed.ncbi.nlm.nih.gov/30799493/
  42. Kamano S. Author's experience of lateral medullary infarction--thermal perception and muscle allodynia. Pain. 2003; 104: 49-53. PubMed: https://pubmed.ncbi.nlm.nih.gov/12855313/
  43. Pereira EAC, Lu G, Wang S, Schwederm. et al. Ventral periaqueductal grey stimulation alters heart rate variability in humans with chronic pain. Exp Neurol. 2001; 223: 574-581. PubMed: https://pubmed.ncbi.nlm.nih.gov/20178783/
  44. Pereira EA, Wang S, Paterson DJ, Stein JF, et al. Sustained reduction of hypertension by deep brain stimulation. J Clin Neurosci. 2010; 17: 124-127. PubMed: https://pubmed.ncbi.nlm.nih.gov/19664927/
  45. Tracey I, Woolf CJ, Andrews A. Composite Pain Biomarker Signatures for Objective Assessment and Effective Treatment. Neuron. 2019; 101: 783-800. PubMed: https://pubmed.ncbi.nlm.nih.gov/30844399/
  46. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011; 63: 240-252. PubMed: https://pubmed.ncbi.nlm.nih.gov/22588748/
  47. Sears C, Machado AG, Nagel SJ, Deogaonkar M, et al. Long-term outcomes of spinal cord stimulation with paddle leads in the treatment of complex regional pain syndrome and failed back surgery syndrome. Neuromodulation. 2011; 14: 312-318. PubMed: https://pubmed.ncbi.nlm.nih.gov/21992424/
  48. Hyam JA, Pereira EA, Mcculloch P, Javed S, et al. Implementing novel trial methods to evaluate surgery for essential tremor. Br J Neurosurg. 2015; 29: 334-339. PubMed: https://pubmed.ncbi.nlm.nih.gov/25757503/
  49. Green AL, Wang S, Stein JF, Pereira EA, et al. Neural signatures in patients with neuropathic pain. Neurology. 2009; 72: 569-571. PubMed: https://pubmed.ncbi.nlm.nih.gov/19204269/
  50. Gross J, Schnitzler A, Timmermann L, Ploner M. Gamma oscillations in human primary somatosensory cortex reflect pain perception. PLoS Biol. 2007; 5: e133. PubMed: https://pubmed.ncbi.nlm.nih.gov/17456008/
  51. Kringelbach ML, Jenkinson N, Green AL, Owen SL, et al. Deep brain stimulation for chronic pain investigated with magnetoencephalography. Neuroreport. 2007; 18: 223-228. PubMed: https://pubmed.ncbi.nlm.nih.gov/17314661/
  52. Pereira EA, Green AL, Bradley KM, Soper: et al. Regional cerebral perfusion differences between periventricular grey, thalamic and dual target deep brain stimulation for chronic neuropathic pain. Stereotact Funct Neurosurg. 2007; 85: 175-183. PubMed: https://pubmed.ncbi.nlm.nih.gov/17389817/
  53. Ray J, Jenkinson N, Kringelbach ML, Hansenc, et al. Abnormal thalamocortical dynamics may be altered by deep brain stimulation: using magnetoencephalography to study phantom limb pain. J Clin Neurosci. 2009; 16: 32-36. PubMed: https://pubmed.ncbi.nlm.nih.gov/19019684/
  54. Horn A, Neumann WJ, Degen K, Schneider GH, Kühn AA. Toward an electrophysiological "sweet spot" for deep brain stimulation in the subthalamic nucleus. Hum Brain Mapp. 2017; 38: 3377-3390. PubMed: https://pubmed.ncbi.nlm.nih.gov/28390148/
  55. Shirvalkar P, Sellers KK, Schmitgen A, Prosky J, Joseph I, et al. A Deep Brain Stimulation Trial Period for Treating Chronic Pain. J Clin Med. 2020; 9(: 3155. PubMed: https://pubmed.ncbi.nlm.nih.gov/33003443/
  56. Anderson WS, O'hara S, Lawson HC, Treede RD, Lenz FA. Plasticity of pain-related neuronal activity in the human thalamus. Prog Brain Res. 2006; 353-364. PubMed: https://pubmed.ncbi.nlm.nih.gov/17046675/
  57. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain. 2005; 9: 463-484. PubMed: https://pubmed.ncbi.nlm.nih.gov/15979027/
  58. Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993; 52: 259-285. PubMed: https://pubmed.ncbi.nlm.nih.gov/7681556/
  59. Melzack R, Coderre TJ, Katz J, Vaccarino AL. Central neuroplasticity and pathological pain. Ann N Y Acad Sci. 2001; 93: 157-174. PubMed: https://pubmed.ncbi.nlm.nih.gov/12000018/
  60. Ossipov MH, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014; 8: 143-151. PubMed: https://pubmed.ncbi.nlm.nih.gov/24752199/
  61. Schweinhardt P, Lee M, Tracey I. Imaging pain in patients: is it meaningful? Curr Opin Neurol. 2006; 19: 392-400. PubMed: https://pubmed.ncbi.nlm.nih.gov/16914979/
  62. Stern J, Jeanmonod D, Sarnthein J. Persistent EEG overactivation in the cortical pain matrix of neurogenic pain patients. Neuroimage. 2006; 31: 721-731. PubMed: https://pubmed.ncbi.nlm.nih.gov/16527493/
  63. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson, Jensen TS, et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007; 14: 952-970. PubMed: https://pubmed.ncbi.nlm.nih.gov/17718686/
  64. Pereira EA, Green AL, Aziz TZ. Deep brain stimulation for pain. Handb Clin Neurol. 2013; 116: 277-294. PubMed: https://pubmed.ncbi.nlm.nih.gov/24112902/

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