Deep Brain Stimulation for Phantom Limb Pain

Keywords: deep brain stimulation, outcome, pain, electrode, functional

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     1300 patients have received deep brain stimulation (DBS) for chronic pain over the last half-century, but few during the last decade.
     Here we evaluate outcomes of DBS of the ventral posterolateral thalamus (VPL) and periaqueductal gray (PVG) for chronic phantom limb pain after amputation.
     14 patients (11 male, 3 female, mean age 52 years) were treated. 11 amputations resulted from trauma, 3 after ischemia (1 bilateral) and 1 from infection. All patients proceeded to full implantation, 6 having contralateral VPL DBS, 4 having contralateral PVG DBS, 1 dual target DBS and 1 bilateral PVG DBS.
     Patients treated from over 9 years from October 2003 to May 2011 by awake surgery in 2 European centers were studied prospectively. Quantitative assessments of pain (Visual Analog Score (VAS)) and quality of life (SF-36) were conducted in both centres alongside additional outcome scores. These were performed before and after surgery at 1-3 months, 6 months and annually.
     Mean VAS reductions were 61% at 1-3 months and 57% at 1 year. Mean SF-36 improvements were 22% at 1-3 months and 13% at 1 year. 4 patients had 4 year outcomes of 36% VAS and 11% SF-36 improvements. Mean DBS parameters were 2.8 volts, 238 microseconds and 22 Hertz. There were no operative complications but 3 patients received electrode revisions, 2 due to electrode damage and 1 to overcome tolerance.
     This is a retrospective study.
     DBS can relieve phantom limb pain.
     Promising 2 center data encourages progression to randomised, controlled clinical trials.


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