Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Post-graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
Neurosurgery. 2020 Feb 1;86(2):191-202. doi: 10.1093/neuros/nyy552.
Deep brain stimulation (DBS) has been considered for patients with intractable pain syndromes since the 1950s. Although there is substantial experience reported in the literature, the indications are contested, especially in the United States where it remains off-label. Historically, the sensory-discriminative pain pathways were targeted. More recently, modulation of the affective sphere of pain has emerged as a plausible alternative.
To systematically review the literature from studies that used contemporary DBS technology. Our aim is to summarize the current evidence of this therapy.
A systematic search was conducted in the MEDLINE, EMBASE, and Cochrane libraries through July 2017 to review all studies using the current DBS technology primarily for pain treatment. Study characteristics including patient demographics, surgical technique, outcomes, and complications were collected.
Twenty-two articles were included in this review. In total, 228 patients were implanted with a definitive DBS system for pain. The most common targets used were periaqueductal/periventricular gray matter region, ventral posterior lateral/posterior medial thalamus, or both. Poststroke pain, phantom limb pain, and brachial plexus injury were the most common specific indications for DBS. Outcomes varied between studies and across chronic pain diagnoses. Two different groups of investigators targeting the affective sphere of pain have demonstrated improvements in quality of life measures without significant reductions in pain scores.
DBS outcomes for chronic pain are heterogeneous thus far. Future studies may focus on specific pain diagnosis rather than multiple syndromes and consider randomized placebo-controlled designs. DBS targeting the affective sphere of pain seems promising and deserves further investigation.
自 20 世纪 50 年代以来，深部脑刺激（DBS）已被考虑用于治疗难治性疼痛综合征患者。尽管文献中有大量的经验报道，但适应证仍存在争议，尤其是在美国，DBS 仍属于超适应证使用。历史上，DBS 主要针对感觉分辨性疼痛通路。最近，疼痛的情感领域的调制已成为一种合理的替代方法。
系统回顾使用当代 DBS 技术的研究文献。我们旨在总结这种治疗方法的现有证据。
通过 2017 年 7 月在 MEDLINE、EMBASE 和 Cochrane 图书馆进行了系统搜索，以综述所有主要使用当前 DBS 技术治疗疼痛的研究。收集了研究特征，包括患者人口统计学、手术技术、结果和并发症。
本综述共纳入 22 篇文章。共有 228 例患者植入了确定性 DBS 系统用于治疗疼痛。最常用的靶点是导水管周围灰质/脑室周围灰质区、腹后外侧/后内侧丘脑或两者。卒中后疼痛、幻肢痛和臂丛损伤是 DBS 最常见的特定适应证。研究之间和各种慢性疼痛诊断之间的结果不同。两组针对疼痛情感领域的研究人员都证明了生活质量指标的改善，而疼痛评分没有明显降低。
迄今为止，DBS 治疗慢性疼痛的结果是异质的。未来的研究可能会专注于特定的疼痛诊断，而不是多种综合征，并考虑随机安慰剂对照设计。DBS 靶向疼痛的情感领域似乎很有前途，值得进一步研究。
