Skip to main content
Log in

Treating Chronic Pain with Deep Brain Stimulation

  • Neuropathic Pain (A Abd-Elsayed, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Deep brain stimulation (DBS) for chronic pain has been controversial. Despite the discouraging outcomes from multicenter clinical trial in the twentieth century, there is sustained interest in optimizing its use to improve patient outcomes. Here we provide a concise overview of DBS for chronic pain as a reference for clinicians.

Recent Findings

Recently published data lends tentative support for DBS as a means of treating chronic pain. Still, high level-of-evidence data remain elusive. There are a handful of ongoing and prospective clinical trials exploring DBS for pain in the context of closed-loop neuromodulation, invasive electroencephalography monitoring, stimulation parameters, and novel intracranial targets.

Summary

DBS is a potentially viable method of treating chronic pain. Procedure success is dependent on a number of factors including proper patient and intracranial target selection. Outcomes for ongoing and future clinical trials will help clinicians refine DBS use for this clinical indication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Iskandar BJ, Nashold BS Jr. History of functional neurosurgery. Neurosurg Clin N Am. 1995;6(1):1–25.

    Article  CAS  Google Scholar 

  2. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9.

    Article  CAS  Google Scholar 

  3. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46(4):489–91.

    Article  CAS  Google Scholar 

  4. Hariz MI, Blomstedt P, Zrinzo L. Deep brain stimulation between 1947 and 1987: the untold story. Neurosurg Focus. 2010;29(2):E1.

    Article  Google Scholar 

  5. •• Bittar RG, Kar-Purkayastha I, Owen SL, Bear RE, Green A, Wang S, et al. Deep brain stimulation for pain relief: a meta-analysis. J Clin Neurosci. 2005;12(5):515–9. Only meta-analysis of DBS for chronic pain within the literature.

    Article  Google Scholar 

  6. •• Coffey RJ. Deep brain stimulation for chronic pain: results of two multicenter trials and a structured review. Pain Med. 2001;2(3):183–92. Provides robust overview of the failed late 20th century Medtronic DBS trials.

    Article  CAS  Google Scholar 

  7. Voges J, Hilker R, Bötzel K, Kiening KL, Kloss M, Kupsch A, et al. Thirty days complication rate following surgery performed for deep-brain-stimulation. Mov Disord. 2007;22(10):1486–9.

    Article  Google Scholar 

  8. Falowski SM. Deep brain stimulation for chronic pain. Curr Pain Headache Rep. 2015;19(7):1–4.

    Article  Google Scholar 

  9. Deer TR, Narouze S, Provenzano DA, Pope JE, Falowski SM, Russo MA, et al. The Neurostimulation Appropriateness Consensus Committee (NACC): recommendations on bleeding and coagulation management in neurostimulation devices. Neuromodulation. 2017;20(1):51–62.

    Article  Google Scholar 

  10. Engel AK, Moll CK, Fried I, Ojemann GA. Invasive recordings from the human brain: clinical insights and beyond. Nat Rev Neurosci. 2005;6(1):35–47.

    Article  CAS  Google Scholar 

  11. Romanelli P, Esposito V. The functional anatomy of neuropathic pain. Neurosurgery Clinics. 2004;15(3):257–68.

    Google Scholar 

  12. Kupers R, Kehlet H. Brain imaging of clinical pain states: a critical review and strategies for future studies. Lancet Neurol. 2006;5(12):1033–44.

    Article  Google Scholar 

  13. Nandi D, Aziz TZ. Deep brain stimulation in the management of neuropathic pain and multiple sclerosis tremor. J Clin Neurophysiol. 2004;21(1):31–9.

    Article  Google Scholar 

  14. Ab Aziz CB, Ahmad AH. The role of the thalamus in modulating pain. Malays J Med Sci. 2006;13(2):11.

    Google Scholar 

  15. Akil H, Richardson D, Hughes J, Barchas JD. Enkephalin-like material elevated in ventricular cerebrospinal fluid of pain patients after analgetic focal stimulation. Science. 1978;201(4354):463–5.

    Article  CAS  Google Scholar 

  16. Davis KD, Taub E, Duffner F, Lozano AM, Tasker RR, Houle S, et al. Activation of the anterior cingulate cortex by thalamic stimulation in patients with chronic pain: a positron emission tomography study. Neurosurg Focus. 2000;8(2):1–6.

    Article  CAS  Google Scholar 

  17. Wallace BA, Ashkan K, Benabid A-L. Deep brain stimulation for the treatment of chronic, intractable pain. Neurosurg Clin. 2004;15(3):343–57.

    Article  Google Scholar 

  18. Keifer OP, Riley JP, Boulis NM. Deep brain stimulation for chronic pain: intracranial targets, clinical outcomes, and trial design considerations. Neurosurgery Clinics. 2014;25(4):671–92.

    Google Scholar 

  19. Abreu V, Vaz R, Rebelo V, Rosas MJ, Chamadoira C, Gillies MJ, et al. Thalamic deep brain stimulation for neuropathic pain: efficacy at three years’ follow-up. Neuromodulation. 2017;20(5):504–13. Recently published report of patient outcomes following DBS for pain.

  20. • Abdallat M, Saryyeva A, Blahak C, Wolf ME, Weigel R, Loher TJ, et al. Centromedian–parafascicular and somatosensory thalamic deep brain stimulation for treatment of chronic neuropathic pain: a contemporary series of 40 patients. Biomedicines. 2021;9(7):731. Recently published report of patient outcomes following DBS for pain.

    Article  Google Scholar 

  21. • Abreu V, Vaz R, Chamadoira C, Rebelo V, Reis C, Costa F, et al. 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(1):52–60. Recently published report of patient outcomes following DBS for pain.

    Article  CAS  Google Scholar 

  22. • Ben-Haim S, Mirzadeh Z, Rosenberg WS. Deep brain stimulation for intractable neuropathic facial pain. Neurosurg Focus. 2018;45(2):E15. Recently published report of patient outcomes following DBS for pain.

    Article  Google Scholar 

  23. • Kashanian A, DiCesare JAT, Rohatgi P, Albano L, Krahl SE, Bari A, et al. Case series: deep brain stimulation for facial pain. Oper Neurosurg (Hagerstown). 2020;19(5):510–7. Recently published report of patient outcomes following DBS for pain.

    Article  Google Scholar 

  24. Leplus A, Lanteri-Minet M, Donnet A, Darmon N, Regis J, Fontaine D. Treatment of chronic refractory pain by combined deep brain stimulation of the anterior cingulum and sensory thalamus (EMOPAIN study): rationale and protocol of a feasibility and safety study. Brain Sci. 2022;12(9):1116.

    Article  Google Scholar 

  25. Spooner J, Yu H, Kao C, Sillay K, Konrad P. Neuromodulation of the cingulum for neuropathic pain after spinal cord injury: case report. J Neurosurg. 2007;107(1):169–72.

    Article  Google Scholar 

  26. Gonzálzez E. Treating the brain by cingulotomy. JAMA. 1980;244(19):2141–3, 6.

    Article  Google Scholar 

  27. Viswanathan A, Harsh V, Pereira EA, Aziz TZ. Cingulotomy for medically refractory cancer pain. Neurosurg Focus. 2013;35(3):E1.

    Article  Google Scholar 

  28. • Levi V, Cordella R, D’Ammando A, Tringali G, Dones I, Messina G, et al. Dorsal anterior cingulate cortex (ACC) deep brain stimulation (DBS): a promising surgical option for the treatment of refractory thalamic pain syndrome (TPS). Acta Neurochir. 2019;161(8):1579–88. Recently published report of patient outcomes following DBS for pain.

    Article  Google Scholar 

  29. • Boccard SG, Prangnell SJ, Pycroft L, Cheeran B, Moir L, Pereira EA, et al. Long-term results of deep brain stimulation of the anterior cingulate cortex for neuropathic pain. World Neurosurg. 2017;106:625–37. Recently published report of patient outcomes following DBS for pain.

    Article  Google Scholar 

  30. Greenberg B, Gabriels L, Malone D, Rezai A, Friehs G, Okun M, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010;15(1):64–79.

    Article  CAS  Google Scholar 

  31. Malone DA Jr, Dougherty DD, Rezai AR, Carpenter LL, Friehs GM, Eskandar EN, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiat. 2009;65(4):267–75.

    Article  Google Scholar 

  32. Plow EB, Malone DA, Machado A. Deep brain stimulation of the ventral striatum/anterior limb of the internal capsule in thalamic pain syndrome: study protocol for a pilot randomized controlled trial. Trials. 2013;14(1):1–10.

    Article  Google Scholar 

  33. Mallory GW, Abulseoud O, Hwang S-C, Gorman DA, Stead SM, Klassen BT, et al., editors. The nucleus accumbens as a potential target for central poststroke pain. Mayo Clinic Proceedings. Elsevier; 2012.

  34. • Lempka SF, Malone DA Jr, Hu B, Baker KB, Wyant A, Ozinga JG IV, et al. Randomized clinical trial of deep brain stimulation for poststroke pain. Ann Neurol. 2017;81(5):653–63. Recently published report of patient outcomes following DBS for pain.

    Article  Google Scholar 

  35. Jones SE, Lempka SF, Gopalakrishnan R, Baker KB, Beall EB, Bhattacharyya P, et al. Functional magnetic resonance imaging correlates of ventral striatal deep brain stimulation for poststroke pain. Neuromodulation. 2021;24(2):259–64.

    Article  Google Scholar 

  36. Mayer DJ, Wolfle TL, Akil H, Carder B, Liebeskind JC. Analgesia from electrical stimulation in the brainstem of the rat. Science. 1971;174(4016):1351–4.

    Article  CAS  Google Scholar 

  37. Reynolds DV. Surgery in the rat during electrical analgesia induced by focal brain stimulation. Science. 1969;164(3878):444–5.

    Article  CAS  Google Scholar 

  38. Sillery E, Bittar RG, Robson MD, Behrens TEJ, Stein J, Aziz TZ, et al. Connectivity of the human periventricular—periaqueductal gray region. J Neurosurg. 2005;103(6):1030–4.

    Article  Google Scholar 

  39. Pereira EA, Lu G, Wang S, Schweder PM, Hyam JA, Stein JF, et al. Ventral periaqueductal grey stimulation alters heart rate variability in humans with chronic pain. Exp Neurol. 2010;223(2):574–81.

    Article  Google Scholar 

  40. •• Yamamoto K, Elias GJ, Beyn ME, Zemmar A, Loh A, Sarica C, et al. Neuromodulation for pain: a comprehensive survey and systematic review of clinical trials and connectomic analysis of brain targets. Stereotact Funct Neurosurg. 2021:1–12. Systematic review of clinical trials involving neuromodulation for chronic pain.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahmed M. Raslan.

Ethics declarations

Conflict of Interest

The authors have no relevant conflicts of interests to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neuropathic Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, H., Yamamoto, E.A., Elkholy, M.A. et al. Treating Chronic Pain with Deep Brain Stimulation. Curr Pain Headache Rep 27, 11–17 (2023). https://doi.org/10.1007/s11916-022-01099-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-022-01099-7

Keywords

Navigation