Abstract
Objectives
Deep brain stimulation (DBS) to treat chronic neuropathic pain has shown variable
outcomes. Variations in pain etiologies and DBS targets are considered the main contributing
factors, which are, however, underexplored owing to a paucity of patient data in individual
studies. An updated meta-analysis to quantitatively assess the influence of these
factors on the outcome of DBS for chronic neuropathic pain is warranted, especially
considering that the anterior cingulate cortex (ACC) has emerged recently as a new
DBS target.
Materials and Methods
A comprehensive literature review was performed in PubMed, Embase, and Cochrane data
bases to identify studies reporting quantitative outcomes of DBS for chronic neuropathic
pain. Pain and quality of life (QoL) outcomes, grouped by etiology and DBS target,
were extracted and analyzed (α = 0.05).
Results
Twenty-five studies were included for analysis. Patients with peripheral neuropathic
pain (PNP) had a significantly greater initial stimulation success rate than did patients
with central neuropathic pain (CNP). Both patients with CNP and patients with PNP
with definitive implant, regardless of targets, gained significant follow-up pain
reduction. Patients with PNP had greater long-term pain relief than did patients with
CNP. Patients with CNP with ACC DBS gained less long-term pain relief than did those
with conventional targets. Significant short-term QoL improvement was reported in
selected patients with CNP after ACC DBS. However, selective reporting bias was expected,
and the improvement decreased in the long term.
Conclusions
Although DBS to treat chronic neuropathic pain is generally effective, patients with
PNP are the preferred population over patients with CNP. Current data suggest that
ACC DBS deserves further investigation as a potential way to treat the affective component
of chronic neuropathic pain.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe toAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Psychiatry. Annu Rev Med. 1954; 5: 223-236
- Deep brain stimulation for pain in the modern era: a systematic review.Neurosurgery. 2020; 86: 191-202
- The current state of deep brain stimulation for chronic pain and its context in other forms of neuromodulation.Brain Sci. 2018; 8: 158
Terminology. International Association for the Study of Pain. Accessed on September 15 2022. http://www.iasp-pain.org/resources/terminology/#Neuropathicpain
- Neuropathic pain.Nat Rev Dis Primers. 2017; 317002
- Long-term outcomes of deep brain stimulation for neuropathic pain.Neurosurgery. 2013; 72 ([discussion: 231]): 221-231
- Deep brain stimulation for the treatment of various chronic pain syndromes.Neurosurg Focus. 2006; 21: E8
- Deep brain stimulation for pain relief: a meta-analysis.J Clin Neurosci. 2005; 12: 515-519
- Targeting the affective component of chronic pain: a case series of deep brain stimulation of the anterior cingulate cortex.Neurosurgery. 2014; 74 (628–35 [discussion: 635])
- Deep brain stimulation: an overview of history, methods, and future developments.Brain Neurosci Adv. 2018; 22398212818816017
- Neuromodulation of the cingulum for neuropathic pain after spinal cord injury: case report.J Neurosurg. 2007; 107: 169-172
- Long-term results of deep brain stimulation of the anterior cingulate cortex for neuropathic pain.World Neurosurg. 2017; 106: 625-637
- Deep brain stimulation of the dorsal anterior cingulate cortex for the treatment of chronic neuropathic pain.Neurosurg Focus. 2015; 38: E11
- Dorsal anterior cingulate cortex (ACC) deep brain stimulation (DBS): a promising surgical option for the treatment of refractory thalamic pain syndrome (TPS).Acta Neurochir (Wien). 2019; 161: 1579-1588
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71
- Deep brain stimulation for trigeminal autonomic cephalalgias.Expert Rev Neurother. 2018; 18: 421-426
- Deep brain stimulation for chronic cluster headache: meta-analysis of individual patient data.Ann Neurol. 2020; 88: 956-969
- Systematic review and meta-analysis: techniques and a guide for the academic surgeon.Ann Cardiothorac Surg. 2015; 4: 112-122
- Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.JAMA. 2000; 283: 2008-2012
- MOOSE reporting guidelines for meta-analyses of observational studies.JAMA Surg. 2021; 156: 787-788
- Meta-analysis of individual participant data: rationale, conduct, and reporting.BMJ. 2010; 340: c221
- Conducting meta-analyses in R with the metafor package.J Stat Softw. 2010; 36: 1-48
- Tractography-guided stimulation of somatosensory fibers for thalamic pain relief.Stereotact Funct Neurosurg. 2013; 91: 328-334
- Centromedian-parafascicular and somatosensory thalamic deep brain stimulation for treatment of chronic neuropathic pain: a contemporary series of 40 patients.Biomedicines. 2021; 9: 731
- Deep brain stimulation for neuropathic cephalalgia.Cephalalgia. 2006; 26: 561-567
- Thalamic deep brain stimulation for neuropathic pain: efficacy at three years’ follow-up.Neuromodulation. 2017; 20: 504-513
- Thalamic field potentials in chronic central pain treated by periventricular gray stimulation-a series of eight cases.Pain. 2003; 101: 97-107
- N-of-1 trials for assessing the efficacy of deep brain stimulation in neuropathic pain.Neuromodulation. 2004; 7: 76-81
- Deep brain stimulation for phantom limb pain.J Clin Neurosci. 2005; 12: 399-404
- Deep brain stimulation for the alleviation of post-stroke neuropathic pain.Pain. 2006; 120: 202-206
- Characteristics of local field potentials correlate with pain relief by deep brain stimulation.Clin Neurophysiol. 2016; 127: 2573-2580
- Oscillatory neural representations in the sensory thalamus predict neuropathic pain relief by deep brain stimulation.Neurobiol Dis. 2018; 109: 117-126
- Dynamic neural state identification in deep brain local field potentials of neuropathic pain.Front Neurosci. 2018; 12: 237
- Functional dynamics of thalamic local field potentials correlate with modulation of neuropathic pain.Eur J Neurosci. 2020; 51: 628-640
- Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: efficacy at five years’ follow-up and effective volume of activated brain tissue.Neurochirurgie. 2022; 68: 52-60
- Deep brain stimulation of the anterior cingulate cortex: targeting the affective component of chronic pain.NeuroReport. 2014; 25: 83-88
- Characterising the analgesic effect of different targets for deep brain stimulation in trigeminal anaesthesia dolorosa.Stereotact Funct Neurosurg. 2016; 94: 174-181
- Diffusion tensor imaging-based thalamic segmentation in deep brain stimulation for chronic pain conditions.Stereotact Funct Neurosurg. 2016; 94: 225-234
- Single electrode deep brain stimulation with dual targeting at dual frequency for the treatment of chronic pain: a case series and review of the literature.Brain Sci. 2017; 7: 9
- Deep brain stimulation for intractable neuropathic facial pain.Neurosurg Focus. 2018; 45: E15
- Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review.J Neurol Surg. 2019; : 1-9
- Somatosensory functional MRI tractography for individualized targeting of deep brain stimulation in patients with chronic pain after brachial plexus injury.Acta Neurochir (Wien). 2019; 161: 2485-2490
- Case Series: Deep brain stimulation for facial pain.Case Series. Oper Neurosurg (Hagerstown). 2020; 19: 510-517
- Electrical thalamic stimulation in the anterior part of the ventral posterolateral nucleus for the treatment of patients with central poststroke pain.Neuromodulation. 2021; 24: 361-372
- Neuropathic pain and deep brain stimulation.Neurotherapeutics. 2014; 11: 496-507
- Deep brain stimulation of the posterior insula in chronic pain: a theoretical framework.Brain Sci. 2021; 11: 639
- Deep brain stimulation of the periaqueductal gray releases endogenous opioids in humans.Neuroimage. 2017; 146: 833-842
Comment
Article info
Publication history
Published online: January 24, 2023
Accepted:
December 1,
2022
Received in revised form:
November 12,
2022
Received:
June 27,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: This work was supported by Beijing Nova Program (Z211100002121050), Tsinghua Precision Medicine Foundation (LC201906), and National Natural Science Foundation of China (U20A20389).
Conflict of Interest: The authors reported no conflict of interest.
Identification
Copyright
© 2022 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
