Central pain is an
expression of a primary or secondary lesion or dysfunction of central nervous
system and represents a very difficult condition to treat. Often
pharmacotherapy allows a benefit clinically important only in a limited number
of patients and clinical use of some drugs is rendered problematic by their
poor handling and tolerability.
Intracranial neurostimulation represents
a reversible method of functional neurosurgery, adaptable and free
of major side effects, indicated in cases of intractable chronic pain when
other conservative treatment modalities have been exhausted. Currently two
types of intracranial neurostimulation are commonly used for control pain: deep
brain stimulation (DBS) and motor cortex stimulation (MCS).
The relief of pain with
chronic electrical stimulation of deep sensory thalamic nuclei (DBS) was first
reported by Mazars et al. and Hosobuchi et al. Although Europe and the United
States over the past 20 years have been several interventions of deep brain stimulation for the
treatment of chronic pain syndromes,
this method over the years has been gradually replaced by less invasive as
spinal cord stimulation, intrathecal infusion pumps and epidural cortical
stimulation. Despite this trend, some conditions of chronic pain refractory to
drugs still represent a valid indication. DBS may be employed for a number of nociceptive and neuropathic pain states, including cluster
headaches, chronic low back pain, failed back surgery syndrome, peripheral
neuropathic pain and facial deafferentation pain. Patients are selected for DBS
for pain if they experienced chronic pain unresponsive to medical or surgical
therapies over many years and to treatment administered during an admission to
a pain clinic.
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