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Thalamic Deep Brain Stimulation for Neuropathic Pain: Efficacy at Three Years' Follow-Up.

Abreu, V; Vaz, R; Rebelo, V; Rosas, MJ; Chamadoira, C; Gillies, MJ; Aziz, TZ; Pereira, EAC (2017) Thalamic Deep Brain Stimulation for Neuropathic Pain: Efficacy at Three Years' Follow-Up. Neuromodulation, 20 (5). pp. 504-513. ISSN 1525-1403 https://doi.org/10.1111/ner.12620
SGUL Authors: Pereira, Erlick Abilio Coelho

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Abstract

OBJECT: Chronic neuropathic pain is estimated to affect 3-4.5% of the worldwide population, posing a serious burden to society. Deep Brain Stimulation (DBS) is already established for movement disorders and also used to treat some "off-label" conditions. However, DBS for the treatment of chronic, drug refractory, neuropathic pain, has shown variable outcomes with few studies performed in the last decade. Thus, this procedure has consensus approval in parts of Europe but not the USA. This study prospectively evaluated the efficacy at three years of DBS for neuropathic pain. METHODS: Sixteen consecutive patients received 36 months post-surgical follow-up in a single-center. Six had phantom limb pain after amputation and ten deafferentation pain after brachial plexus injury, all due to traumas. To evaluate the efficacy of DBS, patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, University of Washington Neuropathic Pain Score (UWNPS), Brief Pain Inventory (BPI), and 36-Item Short-Form Health Survey (SF-36). RESULTS: Contralateral, ventroposterolateral sensory thalamic DBS was performed in sixteen patients with chronic neuropathic pain over 29 months. A postoperative trial of externalized DBS failed in one patient with brachial plexus injury. Fifteen patients proceeded to implantation but one patient with phantom limb pain after amputation was lost for follow-up after 12 months. No surgical complications or stimulation side effects were noted. After 36 months, mean pain relief was sustained, and the median (and interquartile range) of the improvement of VAS score was 52.8% (45.4%) (p = 0.00021), UWNPS was 30.7% (49.2%) (p = 0.0590), BPI was 55.0% (32.0%) (p = 0.00737), and SF-36 was 16.3% (30.3%) (p = 0.4754). CONCLUSIONS: DBS demonstrated efficacy at three years for chronic neuropathic pain after traumatic amputation and brachial plexus injury, with benefits sustained across all pain outcomes measures and slightly greater improvement in phantom limb pain.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Abreu, V., Vaz, R., Rebelo, V., Rosas, M. J., Chamadoira, C., Gillies, M. J., Aziz, T. Z. and Pereira, E. A. C. (2017), Thalamic Deep Brain Stimulation for Neuropathic Pain: Efficacy at Three Years' Follow-Up. Neuromodulation: Technology at the Neural Interface, 20: 504–513, which has been published in final form at http://doi.org/10.1111/ner.12620. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Keywords: Amputation, Brief Pain Inventory, SF-36, University of Washington Neuropathic Pain Score, brachial plexus injury, deep brain stimulation, neuropathic pain, ventral posterolateral thalamus, visual analog scale, Neurology & Neurosurgery, 1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Science
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Neuromodulation
ISSN: 1525-1403
Language: eng
Dates:
DateEvent
4 July 2017Published
20 June 2017Published Online
25 April 2017Accepted
Publisher License: Publisher's own licence
PubMed ID: 28631870
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/109017
Publisher's version: https://doi.org/10.1111/ner.12620

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