Evaluation of Dorsal Column Stimulation in the Treatment of Chronic Pain

Abstract Dorsal column stimulation (DCS) was used in the treatment of chronic intractable pain in 51 patients. Twenty-five of the patients had back and leg pain secondary to the treatment of intervertebral disc disease; 11 had postoperative pain after general or thoracic surgical procedures. The remainder suffered pain related to multiple sclerosis, spinal cord injury, carcinoma, and peripheral vascular disease. Pain had been present for a mean of 24 months. Thirty-seven patients underwent DCS electrode placement by open laminectomy, and 11 had percutaneous epidural DCS electrode placement. Three patients first underwent epidural DCS electrode implantation and subsequently had DCS electrode implantation by laminectomy. No major complications were noted, although multiple lesser complications required 33 additional operative procedures for correction. Follow-up periods ranged from 12 to 67 months, with a mean of 38 months. Immediately after implantation. 47% of the patients reported that they had essentially complete pain relief, but 3 years later this had decreased to 8%. No patient followed for 4 years or longer reported complete pain relief. Thirty-three per cent of the patients discontinued the regular use of narcotics for pain relief after DCS electrode implantation. Unfortunately, only 16% were able to return to gainful employment or full physical activity after DCS. Based on these data and a review of the literature, the following conclusions are made: (a) assessment of success in the treatment of chronic pain is strongly dependent on the criteria used for patient evaluation: (b) with the criteria of this report, DCS is a relatively ineffective treatment for chronic pain; (c) epidural percutaneous DCS systems are no more effective than are those placed by laminectomy, and, because of technical problems with epidural systems (mainly lead breakage and migration), the latter may actually be less effective; and (d) at present DCS seems to play a minor role in the treatment of chronic intractable pain.

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Spinal Epidural Neurostimulation for Treatment of Acute and Chronic Intractable Pain

Neurosurgery ◽

10.1227/00006123-197909000-00007 ◽

1979 ◽

Vol 5 (3) ◽

pp. 344-348 ◽

Cited By ~ 34

Author(s):

Robert R. Richardson ◽

Edir B. Siqueira ◽

Leonard J. Cerullo

Keyword(s):

Pain Relief ◽

Dorsal Column ◽

Therapeutic Modality ◽

Intractable Pain ◽

Significant Pain ◽

Long Term Follow Up ◽

Post Traumatic ◽

Spinal Epidural ◽

Dorsal Column Stimulation

Abstract Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Nashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

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Preliminary percutaneous dorsal column stimulation prior to permanent implantation

Journal of Neurosurgery ◽

10.3171/jns.1972.37.2.0242 ◽

1972 ◽

Vol 37 (2) ◽

pp. 242-245 ◽

Cited By ~ 49

Author(s):

Yoshio Hosobuchi ◽

John E. Adams ◽

Philip R. Weinstein

Keyword(s):

Dorsal Column ◽

Screening Procedure ◽

Intractable Pain ◽

Content Type ◽

Dorsal Column Stimulation ◽

Fine Print

✓ Percutaneous dorsal column stimulation was done as a screening procedure in 34 candidates before implantation of a permanent dorsal column stimulator for the treatment of intractable pain. This procedure was useful in forecasting the tolerance of the patient to the “vibratory sensation” produced by a dorsal column stimulator, and the efficacy of the device in relieving pain. Eight patients termed the “vibratory sensation” intolerable. Sixteen found it unpleasant but preferable to the pain, and two found it actually pleasant.

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Dorsal column stimulation for control of pain

Journal of Neurosurgery ◽

10.3171/jns.1972.36.5.0590 ◽

1972 ◽

Vol 36 (5) ◽

pp. 590-597 ◽

Cited By ~ 159

Author(s):

Blaine S. Nashold ◽

Harry Friedman

Keyword(s):

Dorsal Column ◽

Intractable Pain ◽

Direct Stimulation ◽

Content Type ◽

Burning Pain ◽

Preoperative Selection ◽

Long Term Effect ◽

Dorsal Column Stimulation ◽

Self Stimulation

✓ Thirty patients with chronic intractable pain have had dorsal column implants and a trial of subsequent electrical self-stimulation to relieve the pain. Burning pain originating from damage to the CNS was most often relieved, while chronic bone, joint, and disc pain responded less well. Patients with severe psychiatric factors should be excluded, but preoperative selection is still difficult because of the lack of objective clinical tests. The long-term effect of the implant on the tissues of the dorsal column is still unknown and requires further evaluation. Although relief of pain has been reported for as long as 3 years, much longer follow-ups are necessary to evaluate the efficiency of this system in patients with chronic pain. Direct stimulation of the spinal cord raises a number of interesting questions in regard to perception and sensory phenomena in man but, as yet, there are no answers as to how dorsal column stimulation effects its relief of pain.

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DREZ lesions for relief of pain related to spinal cord injury

Journal of Neurosurgery ◽

10.3171/jns.1986.65.4.0465 ◽

1986 ◽

Vol 65 (4) ◽

pp. 465-479 ◽

Cited By ~ 68

Author(s):

Allan H. Friedman ◽

Blaine S. Nashold

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pain Relief ◽

Intractable Pain ◽

Content Type ◽

Root Entry Zone ◽

Pain Syndromes ◽

Cord Injury ◽

Good Pain Relief

✓ Fifty-six patients with intractable pain following a spinal cord injury were treated with dorsal root entry zone (DREZ) lesions. After a follow-up period ranging from 6 months to 6 years, 50% of patients had good pain relief. Certain pain syndromes tended to respond better to DREZ lesions than did others. Patients with pain extending caudally from the level of the injury and patients with unilateral pain were most likely to obtain pain relief from the procedure; diffuse pain and predominant sacral pain did not respond as well.

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Activation of the anterior cingulate cortex by thalamic stimulation in patients with chronic pain: a positron emission tomography study

Neurosurgical FOCUS ◽

10.3171/foc.2000.8.2.7 ◽

2000 ◽

Vol 8 (2) ◽

pp. 1-6

Author(s):

Karen D. Davis ◽

Ethan Taub ◽

Frank Duffner ◽

Andres M. Lozano ◽

Ronald R. Tasker ◽

...

Keyword(s):

Positron Emission Tomography ◽

Chronic Pain ◽

Pain Relief ◽

Anterior Cingulate Cortex ◽

Analgesic Effect ◽

Cingulate Cortex ◽

Anterior Cingulate ◽

Emission Tomography ◽

Intractable Pain ◽

Positron Emission

Object Deep brain stimulation (DBS) of the sensory thalamus has been used to treat chronic, intractable pain. The goal of this study was to investigate the thalamocortical pathways activated during thalamic DBS. Methods The authors compared positron emission tomography (PET) images obtained before, during, and after DBS in five patients with chronic pain. Two of the five patients reported significant DBS-induced pain relief during PET scanning, and the remaining three patients did not report any analgesic effect of DBS during scanning. The most robust effect associated with DBS was activation of the anterior cingulate cortex (ACC). An anterior ACC activation was sustained throughout the 40 minutes of DBS, whereas a more posteriorly located ACC activation occurred at a delay after onset of DBS, although these activations were not dependent on the degree of pain relief reported during DBS. However, implications specific to the analgesic effect of DBS require further study of a larger, more homogeneous patient population. Additional effects of thalamic DBS were detected in motor-related regions (the globus pallidus, cortical area 4, and the cerebellum) and visual and association cortical areas. Conclusions The authors demonstrate that the ACC is activated during thalamic DBS in patients with chronic pain.

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