Deep Brain Stimulation
Indication: Neuropathic Pain
Deep brain stimulation (DBS) was first introduced in the 1950s. This technique has been used to treat intractable low back pain (failed back surgery), post-stroke pain, phantom limb pain and pain due to peripheral neuropathies. DBS may be a useful tool when all other modalities have failed. Stimulation sites include the periventricular/periaqueductal grey matter (PVG/PAG), internal capsule (IC), and sensory thalamus (ST). Owen reported a success rate of 70% for treatment of post-stroke pain in an open label study of 15 patients (57).
However, multiple reports presented inconsistent results. FDA regulations prohibited the use of DBS to treat pain in the USA between late 1980s and 1990s, and later the FDA designated DBS treatment of pain as ‘off-label’. Currently, the general consensus remains doubtful regarding the efficacy DBS for chronic pain. In contrast, motor cortex and spinal cord stimulation may provide more effective and reliable pain relief.