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Review
. 2014 Jan;25(1):77-83.
doi: 10.1016/j.nec.2013.08.011. Epub 2013 Oct 10.

Central neuromodulation for refractory pain

Nina Z Moore  1 , Scott F Lempka, Andre Machado
Affiliations
Review

Central neuromodulation for refractory pain

Nina Z Moore et al. Neurosurg Clin N Am. 2014 Jan.

Abstract

Chronic neuropathic pain affects 8.2% of adults, extrapolated to roughly 18 million people every year in the United States. Patients who have pain that cannot be controlled with pharmacologic management or less invasive techniques can be considered for deep brain stimulation or motor cortex stimulation. These techniques are not currently approved by the Food and Drug Administration for chronic pain and are, thus, considered off-label use of medical devices for this patient population. Conclusive effectiveness studies are still needed to demonstrate the best targets as well as the reliability of the results with these approaches.

Keywords: Deep brain stimulation (DBS); Motor cortex stimulation (MCS); Neuromatrix; Neuromodulation; Pain.

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Figures

Fig. 1
Fig. 1
DBS targets for pain management. (A) More traditional DBS targets aimed at treating the sensory-discriminative component of pain. The image shows the preoperative magnetic resonance imaging (MRI) and corresponding lead (model 3387, Medtronic, Minneapolis, MN) locations for a patient with one DBS lead in the VPL/VPM and a second DBS lead in the PVG. Both sagittal and coronal slices are shown near the distal ends of the leads. The patient-specific lead locations and trajectories were determined using the software Cicerone v1.3. (B) A recently proposed DBS target aimed at treating the affective-motivational component of pain. The image shows an oblique coronal view of the postoperative MRI for a patient with bilateral DBS leads (Medtronic model 3391) implanted in the ventral capsule and ventral striatal (VC/VS) area. It is possible to see the 4 electrodes in the right hemisphere as well as the distal end of the DBS lead implanted in the left hemisphere.
See this image and copyright information in PMC

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