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Mercer Lindsay N, Chen C, Gilam G, Mackey S, Scherrer G. Brain circuits for pain and its treatment. Sci Transl Med 2021; 13:eabj7360. [PMID: 34757810 DOI: 10.1126/scitranslmed.abj7360] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Nicole Mercer Lindsay
- Department of Cell Biology and Physiology, UNC Neuroscience Center, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Biology, CNC Program, Department of Applied Physics, Stanford University, Stanford, CA 94305, USA
| | - Chong Chen
- Department of Cell Biology and Physiology, UNC Neuroscience Center, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gadi Gilam
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Grégory Scherrer
- Department of Cell Biology and Physiology, UNC Neuroscience Center, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,New York Stem Cell Foundation-Robertson Investigator, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Park HH, Kim WH, Jung HH, Chang JH, Lee KS, Chang WS, Hong CK. Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia. Neurosurg Rev 2020; 43:1631-1640. [PMID: 32642933 DOI: 10.1007/s10143-020-01346-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS. The predominant origin of PCMs was upper clival (49%) with trigeminal nerve compression at the medial dorsal root entry zone. Tumor control rates were equally 94% with GKRS or MS for a mean tumor size and volume of 2.3 cm and 5.3 cm3, respectively. The preoperative BNI scores were mostly II (40%) and IV (37%) with GKRS and MS, respectively. TN relief without medications (BNI scores I and II) was achieved in 13 of 35 patients (37%) with GKRS and 32 of 35 patients (91%) with MS during a mean follow-up of 50.5 months. The most common complications after GKRS and MS were dysesthesia (23%) and diplopia (9%), respectively. MS could be more effective than GKRS in providing prompt, medication-free pain relief from TN for small PCMs. The risks of MS have to be considered carefully in experienced hands, especially for small PCMs.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Woo Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Hyun-Ho Jung
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis. Sci Rep 2020; 10:7195. [PMID: 32346080 PMCID: PMC7189245 DOI: 10.1038/s41598-020-64177-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/10/2020] [Indexed: 01/21/2023] Open
Abstract
Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990's for the treatment of chronic neuropathic orofacial pain (CNOP), although its effectiveness remains doubtful. However, CNOP is known to be a heterogeneous group of orofacial pain disorders, which can lead to different responses to iMCS. Therefore, this paper investigated (1) whether the effectiveness of iMCS is significantly different among different CNOP disorders and (2) whether other confounding factors can be impacting iMCS results in CNOP. A systematic review and meta-analysis using a linear mixed-model was performed. Twenty-three papers were included, totaling 140 CNOP patients. Heterogeneity of the studies showed to be 55.8%. A visual analogue scale (VAS) measured median pain relief of 66.5% (ranging from 0-100%) was found. Linear mixed-model analysis showed that patients suffering from trigeminal neuralgia responded significantly more favorable to iMCS than patients suffering from dysfunctional pain syndromes (p = 0.030). Also, patients suffering from CNOP caused by (supra)nuclear lesions responded marginally significantly better to iMCS than patients suffering from CNOP due to trigeminal nerve lesions (p = 0.049). No other confounding factors were elucidated. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. No other confounding factors were found relevant.
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Chronic subdural cortical stimulation for phantom limb pain: report of a series of two cases. Acta Neurochir (Wien) 2019; 161:925-934. [PMID: 30790089 DOI: 10.1007/s00701-019-03828-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
Phantom limb pain is a complex, incompletely understood pain syndrome that is characterized by chronic painful paresthesias in a previous amputated body part. Limited treatment modalities exist that provide meaningful relief, including pharmacological treatments and spinal cord stimulation that are rarely successful for refractory cases. Here, we describe our two-patient cohort with recalcitrant upper extremity phantom limb pain treated with chronic subdural cortical stimulation. The patient with evidence of cortical reorganization and almost 60 years of debilitating phantom limb pain experienced sustained analgesic relief at a follow-up period of 6 months. The second patient became tolerant to the stimulation and his pain returned to baseline at a 1-month follow-up. Our unique case series report adds to the growing body of literature suggesting critical appraisal before widespread implementation of cortical stimulation for phantom limb pain can be considered.
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Mo JJ, Hu WH, Zhang C, Wang X, Liu C, Zhao BT, Zhou JJ, Zhang K. Motor cortex stimulation: a systematic literature-based analysis of effectiveness and case series experience. BMC Neurol 2019; 19:48. [PMID: 30925914 PMCID: PMC6440080 DOI: 10.1186/s12883-019-1273-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Aim to quantitatively analyze the clinical effectiveness for motor cortex stimulation (MCS) to refractory pain. Methods The literatures were systematically searched in database of Cocharane library, Embase and PubMed, using relevant strategies. Data were extracted from eligible articles and pooled as mean with standard deviation (SD). Comparative analysis was measured by non-parametric t test and linear regression model. Results The pooled effect estimate from 12 trials (n = 198) elucidated that MCS shown the positive effect on refractory pain, and the total percentage improvement was 35.2% in post-stroke pain and 46.5% in trigeminal neuropathic pain. There is no statistical differences between stroke involved thalamus or non-thalamus. The improvement of plexus avulsion (29.8%) and phantom pain (34.1%) was similar. The highest improvement rate was seen in post-radicular plexopathy (65.1%) and MCS may aggravate the pain induced by spinal cord injury, confirmed by small sample size. Concurrently, Both the duration of disease (r = 0.233, p = 0.019*) and the time of follow-up (r = 0.196, p = 0.016*) had small predicative value, while age (p = 0.125) had no correlation to post-operative pain relief. Conclusions MCS is conducive to the patients with refractory pain. The duration of disease and the time of follow-up can be regarded as predictive factor. Meanwhile, further studies are needed to reveal the mechanism of MCS and to reevaluate the cost-benefit aspect with better-designed clinical trials. Electronic supplementary material The online version of this article (10.1186/s12883-019-1273-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jia-Jie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Wen-Han Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Chang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Bao-Tian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Jun-Jian Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Hussein AE, Esfahani DR, Moisak GI, Rzaev JA, Slavin KV. Motor Cortex Stimulation for Deafferentation Pain. Curr Pain Headache Rep 2018; 22:45. [PMID: 29796941 DOI: 10.1007/s11916-018-0697-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Since the early 1990s, motor cortex stimulation (MCS) has been a unique treatment modality for patients with drug-resistant deafferentation pain. While underpowered studies and case reports have limited definitive, data-driven analysis of MCS in the past, recent research has brought new clarity to the MCS literature and has helped identify appropriate indications for MCS and its long-term efficacy. RECENT FINDINGS In this review, new research in MCS, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) are analyzed and compared with historical landmark papers. Currently, MCS is effective in providing relief to 40-64% of patients, with decreasing analgesic effect over time addressed by altering stimulation settings. rTMS and tDCS, two historic, non-invasive stimulation techniques, are providing new alternatives for the treatment of deafferentation pain, with rTMS finding utility in identifying MCS responders. Future advances in electrode arrays, neuro-navigation, and high-definition tDCS hold promise in providing pain relief to growing numbers of patients. Deafferentation pain is severe, disabling, and remains a challenge for patients and providers alike. Over the last several years, the MCS literature has been revitalized with studies and meta-analyses demonstrating MCS effectiveness and providing guidance in identifying responders. At the same time, rTMS and tDCS, two time-honored non-invasive stimulation techniques, are finding new utility in managing deafferentation pain and identifying good MCS candidates. As the number of potential therapies grow, the clinician's role is shifting to personalizing treatment to the unique pain of each patient. With new treatment modalities, this form of personalized medicine is more possible than ever before.
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Affiliation(s)
- Ahmed E Hussein
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N NPI, (MC 799), Chicago, IL, 60612, USA
| | - Darian R Esfahani
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N NPI, (MC 799), Chicago, IL, 60612, USA
| | - Galina I Moisak
- Federal Neurosurgical Center of Novosibirsk, Novosibirsk, Russian Federation
| | - Jamil A Rzaev
- Federal Neurosurgical Center of Novosibirsk, Novosibirsk, Russian Federation
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N NPI, (MC 799), Chicago, IL, 60612, USA.
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8
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Huang J, Ni Z, Finch P. Gasserian Ganglion and Retrobulbar Nerve Block in the Treatment of Ophthalmic Postherpetic Neuralgia: A Case Report. Pain Pract 2017; 17:961-967. [DOI: 10.1111/papr.12547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/12/2016] [Accepted: 10/19/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Jie Huang
- Department of Physical and Rehabilitation Medicine; Shenyang Medical College; Shenyang China
| | - Zhongge Ni
- Department of Physical and Rehabilitation Medicine; Shenyang Medical College; Shenyang China
- Shenyang Dong-Ao Pain Management Clinic; Shenyang China
| | - Philip Finch
- Perth Pain Management Centre; South Perth Western Australia Australia
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Rasche D, Tronnier VM. Clinical Significance of Invasive Motor Cortex Stimulation for Trigeminal Facial Neuropathic Pain Syndromes. Neurosurgery 2016; 79:655-666. [DOI: 10.1227/neu.0000000000001353] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
BACKGROUND:
Invasive neuromodulation of the cortical surface for various chronic pain syndromes has been performed for >20 years. The significance of motor cortex stimulation (MCS) in chronic trigeminal neuropathic pain (TNP) syndromes remains unclear. Different techniques are performed worldwide in regard to operative procedure, stimulation parameters, test trials, and implanted materials.
OBJECTIVE:
To present the clinical experiences of a single center with MCS, surgical approach, complications, and follow-up as a prospective, noncontrolled clinical trial.
METHODS:
The implantation of epidural leads over the motor cortex was performed via a burr hole technique with neuronavigation and intraoperative neurostimulation. Special focus was placed on a standardized test trial with an external stimulation device and the implementation of a double-blinded or placebo test phase to identify false-positive responders.
RESULTS:
A total of 36 patients with TNP were operated on, and MCS was performed. In 26 of the 36 patients (72%), a significant pain reduction from a mean of 8.11 to 4.58 (on the visual analog scale) during the test trial was achieved (P <.05). Six patients were identified as false-positive responders (17%). At the last available follow-up of 26 patients (mean, 5.6 years), active MCS led to a significant pain reduction compared with the preoperative pain ratings (mean visual analog scale score, 5.01; P <.05).
CONCLUSION:
MCS is an additional therapeutic option for patients with refractory chronic TNP, and significant long-term pain suppression can be achieved. Placebo or double-blinded testing is mandatory.
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Affiliation(s)
- Dirk Rasche
- Department of Neurosurgery, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Volker M. Tronnier
- Department of Neurosurgery, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
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Bir SC, Maiti TK, Bollam P, Nanda A. Management of Recurrent Trigeminal Neuralgia Associated with Petroclival Meningioma. J Neurol Surg B Skull Base 2015; 77:47-53. [PMID: 26949588 DOI: 10.1055/s-0035-1558834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/11/2015] [Indexed: 12/26/2022] Open
Abstract
Objective Petroclival meningioma (PM) presents with trigeminal neuralgia (TN) in < 5% of cases. Neurosurgeons often face the dilemma of formulating a treatment protocol when TN recurs. In this study, we sought to set up a protocol in patients with PM who had a recurrent TN. Materials and Methods We performed a retrospective review of 57 patients with PM. Of the 57 patients, only 7 patients presented with TN, and six patients experienced recurrent TN. The study population was evaluated clinically and radiographically after treatment. Results Overall improvement of pain control after various treatments was 67%, and tumor control was 100%. The pain-free period was 2 years for the Gamma Knife radiosurgery (GKRS) group and 4 years for the resection group when treated as a primary treatment (p = 0.034). Of the six patients, four patients had Barrow Neurosurgical Institute (BNI) score I (no TN, no medication), and two patients had BNI score III (some pain controlled with medication). The Karnofsky performance scale score was significantly improved after treatment compared with the pretreated status (78 versus 88; p = 0.044). Conclusion Microsurgical resection is superior to GKRS in achieving and maintaining pain-free status in patients with recurrent trigeminal pain associated with PM.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
| | - Tanmoy Kumar Maiti
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
| | - Papireddy Bollam
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
| | - Anil Nanda
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
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Fricová J, Klírová M, Masopust V, Novák T, Vérebová K, Rokyta R. Repetitive transcranial magnetic stimulation in the treatment of chronic orofacial pain. Physiol Res 2014; 62:S125-34. [PMID: 24329692 DOI: 10.33549/physiolres.932575] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is non-invasive neuromodulation method. We applied rTMS for the treatment of farmacoresistant chronic orofacial pain. We compared the effect of 10 Hz and 20 Hz stimulation. The study included 23 patients for 20 Hz stimulation and 36 patients for 10 Hz stimulation with pharmacotherapy resistant chronic facial pain aged 33-65 years with pain duration of at least 6 months. Monitoring of treatment effects was performed within 15 minutes of each rTMS application (days 1-5) and finally stimulation (active vs. sham coil). If compared with data with 10 Hz rTMS study (n=36) and with 20 Hz rTMS (n=23) trials using a parallel design. Only the results obtained in a series of five rTMS treatments in the first step (active n=24, sham n=12), that 20 Hz frequency rTMS using a higher intensity (95 % of motor threshold) to be equally effective relative to VAS (Visual analogue scale) and QST (quantitative sensory testing). In conclusions, the better results with the relief of orofacial pain were obtained with 20 Hz stimulation if compared with 10 Hz stimulation. It was proved with subjective (VAS) and objective evaluation (QST). rTMS can be used in the treatment of chronic intractable pain.
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Affiliation(s)
- J Fricová
- Pain Management Center, Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic.
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Abstract
Motor cortex stimulation produces significant relief of symptoms in many forms of refractory chronic pain disorders.
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Affiliation(s)
- Thomas Ostergard
- Department of Neurological Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Charles Munyon
- Department of Neurological Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Jonathan P Miller
- Department of Neurological Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Parmar VK, Gee L, Smith H, Pilitsis JG. Supraspinal stimulation for treatment of refractory pain. Clin Neurol Neurosurg 2014; 123:155-63. [PMID: 24956545 DOI: 10.1016/j.clineuro.2014.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/21/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
Refractory pain syndromes often have far reaching effects and are quite a challenge for primary care providers and specialists alike to treat. With the help of site-specific neuromodulation and appropriate patient selection these difficult to treat pain syndromes may be managed. In this article, we focus on supraspinal stimulation (SSS) for treatment of intractable pain and discuss off-label uses of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in context to emerging indications in neuromodulation. Consideration for neuromodulatory treatment begins with rigorous patient selection based on exhaustive conservative management, elimination of secondary gains, and a proper psychology evaluation. Trial stimulation prior to DBS is nearly always performed while trial stimulation prior to MCS surgery is symptom dependent. Overall, a review of the literature demonstrates that DBS should be considered for refractory conditions including nociceptive/neuropathic pain, phantom limb pain, and chronic cluster headache (CCH). MCS should be considered primarily for trigeminal neuropathic pain (TNP) and central pain. DBS outcome studies for post-stroke pain as well as MCS studies for complex regional pain syndrome (CRPS) show more modest results and are also discussed in detail.
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Affiliation(s)
- V K Parmar
- Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA
| | - L Gee
- Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA
| | - H Smith
- Department of Anesthesia, Albany Medical College, Albany, NY 12208, USA
| | - J G Pilitsis
- Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA; Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany NY 12208, USA.
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Monsalve GA. Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature. Surg Neurol Int 2012; 3:S290-311. [PMID: 23230534 PMCID: PMC3514920 DOI: 10.4103/2152-7806.103023] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 09/11/2012] [Indexed: 11/05/2022] Open
Abstract
Background: Facial chronic neuropathic pain (FCNP) is a disabling clinical entity, its incidence is increasing within the chronic pain population. There is indication for neuromodulation when conservative treatment fails. Motor cortex stimulation (MCS) has emerged as an alternative in the advanced management of these patients. The aim of this work is to review the worldwide literature on MCS for FCNP. Methods: A PubMed search from 1990 to 2012 was conducted using established MeSH words. A total of 126 relevant articles on MCS focused on chronic pain were selected and analysed. Series of cases were divided in (1) series focused on MCS for FCNP, and (2) MCS series of FCNP mixed with other chronic pain entities. Results: A total of 118 patients have been trialed for MCS for FCNP, 100 (84.7%) pursued permanent implantation of the system, and 84% of them had good pain control at the end of the study. Male: female ratio was about 1:2 in the whole group of studies; mean age was 58 years (range, 28–83), and mean pain duration was 7 years (range, 0.6–25). Four randomized controlled studies have been reported, all of them not focused on MCS for FCNP. The most common complication was seizure followed by wound infection. Preoperative evaluation, surgical techniques, and final settings varied among the series. Conclusion: MCS for FNCP is a safe and efficacious treatment option when previous managements have failed; however, there is still lack of strong evidence (larger randomized controlled multicentre studies) that MCS can be offered in a regular basis to FNCP patients.
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Andrews DW, Farrell CJ. We can control the tumor but can we stop the pain? World Neurosurg 2012; 80:290-2. [PMID: 22634457 DOI: 10.1016/j.wneu.2012.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/21/2012] [Indexed: 11/25/2022]
Affiliation(s)
- David W Andrews
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
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