Electrical stimulation of the brain for relief of intractable pain due to cancer.

Seventeen patients with intractable pain due to progressive malignancies were treated by electrical stimulation of the brain after more conventional pain therapies applied in the University of California, Los Angeles Cancer Pain Clinic had failed. Electrodes were stereotactically implanted under local anesthesia in the periaqueductal grey (PAG) or periventricular grey (PVG) in 11 patients. In six patients electrodes were placed in both PAG-PVG targets and in the sensory thalamic nuclei. Thirteen of the 17 patients achieved virtually total pain relief and 2 others achieved partial pain relief. At the hospital discharge only 4 of 17 patients required narcotic analgesics for pain relief. Follow-up periods ranged from 1 to 21 months and 6 patients remain alive. Fourteen patients eventually required narcotics for pain relief, usually in the terminal few weeks of their lives. Pain relief was achieved in spite of the fact that all patients were tolerant to large doses of systematically or intraspinally administered narcotics at the time of electrode placement. No complications related to brain stimulation were identified. Brain stimulation is a safe and effective method for treatment of intractable pain due to malignancy in certain patients.