Deep Brain Stimulation

Deep brain stimulation (DBS) is increasing in popularity due to its successful treatment of movement disorders and its relatively low risk profile. However, its use for refractory, chronic pain syndromes actually precedes its use in movement disorders. Although the precise mechanism remains unknown, both neuropathic and nociceptive pain have been successfully treated with DBS with some studies noting greater success with nociceptive pain in particular. Common targets for the treatment of pain utilizing DBS include the periventricular/periaqueductal gray area (PVG/PAG); sensory thalamus, particularly the ventral posterolateral/medial nucleus (VPL/VPM); anterior cingulate cortex (ACC); posterior hypothalamus (PH); center median-parafascicular (CM-Pf) complex; and internal capsule. Targets are typically chosen on the basis of clinical presentation, with some studies suggesting coverage of multiple targets in order to ensure relief of complex pain syndromes. Additional research is necessary to uncover mechanism of action, proper stimulation targets, and efficacy of the DBS therapy.