The history of brain surgery and stimulation for pain is long and too frequently disappointing.
This author had the privilege of speaking to one of the great pain surgeons of the former generation, a man who had done more cingulectomies perhaps than anyone alive, who was also a member of the Royal Academy. That conversation revealed that while cingulectomy caused the patients to talk about pain less, the surgeon was not convinced they were actually having less pain. He stopped the removal of the cingulum as a consequence. His concern was that flat affect following surgery was being mistaken for pain relief. Admittedly, his work was done before the development of stereotactic location of precise brain areas, and so today’s surgeons may find things differently.
Now, we see an attempt to implant deep brain electrodes by Resche et al in the Neurosurg Focus. 2006 Dec 15;21(6).
This study is more interesting than any so far published because the surgeons differentiated not only nociceptive pain from neuropathic pain, but they also differentiated pain from peripheral nerve injury and central pain.
In 56 patients with pain of various sorts, including mixed, it was found that patients with low back pain did well with deep brain stimulation in the somatosensory thalamus and periventricular gray. Also doing very well were those with complex regional pain syndrome. However, the results in those with central pain was disappointing. Once again, the data do not seem to support the contention that Deep Brain Stimulation is a reliable method for relieving central pain.
In contrast, is stimulation of the MOTOR cortex. Work at Duke by Osenbach was reported in Neurosurg Focus. 2006 Dec 15;21(6):E7. The author here found benefit for those with trigeminal neuropathic pain and also post stroke pain. No description of results for those with spinal cord injury pain was included. The author is optimistic about motor cortex stimulation, but indicates that a noninvasive approach with transcranial DC stimulation should be studied as well.
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