Pires Mariana P, McBenedict Billy, Ahmed Issra E, Yau Ryan Chun Chien, Fong Yan Bin, Goh Kang Suen, Lim Yee Siew, Mohamed Suber Abdi, Ngu Owen, Devan Jeshua N, Hauwanga Wilhelmina N, Lima Pessôa Bruno
Neurosurgery, Fluminense Federal University, Niterói, BRA.
Surgery, National Ribat University, Khartoum, SDN.
Cureus. 2024 May 12;16(5):e60130. doi: 10.7759/cureus.60130. eCollection 2024 May.
Neuropathic pain (NP), resulting from damage to the somatosensory system, is characterized by either spontaneous or evoked pain. In the context of NP, wherein aberrant signaling pathways contribute to the perception of pain, the thalamus emerges as a key player. This structure is integral to the pain network that includes connections to the dorsal horn of the spinal cord, highlighting its role in the affective-motivational aspects of pain perception. Given its significant involvement, the thalamus is targeted in advanced treatments such as thalamotomy and deep brain stimulation (DBS) when traditional therapies fail, emphasizing the need to understand its function in NP to improve management strategies. This review aimed to provide an overview of the role of the thalamus in the transmission of nociceptive information in NP by discussing the existing evidence, including the effectiveness and safety of current techniques in the management and treatment of NP. This is an integrative review involving the qualitative analysis of scientific articles published in PubMed/MEDLINE, Embase, Scopus, and Web of Science. A total of 687 articles were identified, and after selection, 15 articles were included in this study. All studies reviewed demonstrated varying degrees of effectiveness of DBS and thalamotomy in alleviating painful symptoms, although the relief was often temporary. Many studies noted a reduction in pain perception at the conclusion of treatment compared to pre-treatment levels, with this decrease maintained throughout patient follow-ups. However, adverse events associated with these treatments were also reported. In conclusion, there are some benefits, albeit temporary, to using thalamotomy and DBS to alleviate the painful symptoms of NP. Both procedures are considered advanced forms of surgical intervention that aim to modulate pain pathways in the brain, providing significant relief for patients suffering from chronic pain resistant to conventional treatment. Despite limitations, these surgical interventions offer renewed hope for patients facing disabling chronic pain and can provide a significant improvement in quality of life.
神经性疼痛（NP）由躯体感觉系统损伤引起，其特征为自发性疼痛或诱发性疼痛。在NP的背景下，异常的信号通路导致疼痛感知，丘脑成为关键因素。该结构是疼痛网络的重要组成部分，与脊髓背角相连，突出了其在疼痛感知的情感 - 动机方面的作用。鉴于其重要作用，当传统疗法无效时，丘脑成为丘脑切开术和深部脑刺激（DBS）等先进治疗的靶点，这凸显了了解其在NP中的功能以改进管理策略的必要性。本综述旨在通过讨论现有证据，包括当前技术在NP管理和治疗中的有效性和安全性，概述丘脑在NP中伤害性信息传递中的作用。这是一项综合综述，涉及对发表在PubMed/MEDLINE、Embase、Scopus和科学网的科学文章进行定性分析。共识别出687篇文章，经过筛选，本研究纳入了15篇文章。所有综述的研究均表明DBS和丘脑切开术在缓解疼痛症状方面有不同程度的有效性，尽管缓解通常是暂时的。许多研究指出，与治疗前水平相比，治疗结束时疼痛感知有所降低，且在患者随访期间这种降低一直保持。然而，也报告了与这些治疗相关的不良事件。总之，使用丘脑切开术和DBS缓解NP的疼痛症状有一些益处，尽管是暂时的。这两种手术都是旨在调节大脑疼痛通路的先进手术干预形式，为患有对传统治疗耐药的慢性疼痛的患者提供了显著缓解。尽管存在局限性，但这些手术干预为面临致残性慢性疼痛的患者带来了新的希望，并可显著改善生活质量。
