Abstract
Neurostimulation therapy is indicated for neuropathic pain that is refractory to medical treatment, and includes stimulation of the dorsal spinal cord, deep brain structures, and the precentral motor cortex. Spinal cord stimulation is validated in the treatment of selected types of chronic pain syndromes, such as failed back surgery syndrome. Deep brain stimulation (DBS) has shown promise as a treatment for peripheral neuropathic pain and phantom limb pain. Compared with DBS, motor cortex stimulation (MCS) is currently more frequently used, mainly because it is more easily performed, and has a wider range of indications (including central poststroke pain). Controlled trials have demonstrated the efficacy of MCS in the treatment of various types of neuropathic pain, although these trials included a limited number of patients and need to be confirmed by large, controlled, multicenter studies. Despite technical progress in neurosurgical navigation, results from studies of MCS are variable, and validated criteria for selecting good candidates for implantation are lacking. However, the evidence in favor of MCS is sufficient to include it in the range of therapeutic options for refractory neuropathic pain. In this Review, the respective efficacies and mechanisms of action of DBS and MCS are discussed.
Key Points
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Neurostimulation therapy is indicated for drug-resistant neuropathic pain
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Neurostimulation therapy for pain mainly includes spinal cord stimulation, deep brain stimulation, and motor cortex stimulation
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Motor cortex stimulation is more easily performed and has currently a wider range of indications than deep brain stimulation
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The efficacy of motor cortex stimulation has been demonstrated in the treatment of neuropathic pain by a small number of controlled trials
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The criteria for selecting good candidates for deep brain or motor cortex stimulation still remain to be clearly delineated
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J.-P. Nguyen, J. Nizard and J.-P. Lefaucheur researched the data for the article. Y. Keravel provided a substantial contribution to discussions of the content. J.-P. Nguyen, J. Nizard and J.-P. Lefaucheur contributed equally to writing the first draft of the article. J.-P. Lefaucheur reviewed and edited the final version of the manuscript.
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Nguyen, JP., Nizard, J., Keravel, Y. et al. Invasive brain stimulation for the treatment of neuropathic pain. Nat Rev Neurol 7, 699–709 (2011). https://doi.org/10.1038/nrneurol.2011.138
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DOI: https://doi.org/10.1038/nrneurol.2011.138
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