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Targeting the Affective Component of Chronic Pain: A Case Series of Deep Brain Stimulation of the Anterior Cingulate Cortex

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  • Sandra G.J. Boccard, 1Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, 2Department of Psychiatry, University of Oxford, UK., Denmark
  • James J Fitzgerald
  • ,
  • Erlick A.C. Pereira, Denmark
  • Liz Moir
  • ,
  • Tim Johannes van Hartevelt, Denmark
  • Morten L Kringelbach
  • Alexander L Green
  • ,
  • Tipu Z Aziz

BACKGROUND:: Deep brain stimulation (DBS) has shown considerable promise for relieving nociceptive and neuropathic symptoms of refractory chronic pain. Nevertheless, for some patients, standard DBS for pain remains poorly efficacious. Pain is a multi-dimensional experience with an affective component: the unpleasantness. The anterior cingulate cortex (ACC) is a structure involved in this affective component and targeting it may relieve patients.

OBJECTIVE:: To describe the first case series of ACC DBS to relieve the affective component of chronic neuropathic pain.

METHODS:: 16 patients (13 males and 3 females) with neuropathic pain underwent bilateral ACC DBS. Mean age at surgery was 48.7 [33-63] years. Patient reported outcome measures were collected before and after surgery, using a Visual Analogue Scale (VAS), Short Form 36 quality of life survey (SF-36), McGill pain questionnaire (MPQ) and EuroQol-5D questionnaires (EQ-5D; Health state).

RESULTS:: 15 patients (93.3 %) transitioned from externalized to fully internalized systems. 11 patients had data to be analyzed with a mean follow-up of 13.2 months. Post-surgery, VAS dropped below 4 for 5 of the patients, with one patient freed from pain. Highly significant improvement of EQ-5D was observed (mean +20.3%, range +0% to +83%, p=0.008). Moreover, statistically significant improvements were observed for the PF (physical functioning) and BP (bodily pain) domains of the SF-36 quality of life survey: mean +64.7% (range -8.9% to +276%, p=0.015) and mean +39.0% (range -33.8% to +159%, p=0.050), respectively.

CONCLUSION:: Affective ACC DBS can relieve chronic neuropathic pain refractory to pharmacotherapy and restore quality of life.

Original languageEnglish
JournalNeurosurgery
Volume74
Issue6
Pages (from-to)628-637
ISSN0148-396X
DOIs
Publication statusPublished - 15 Apr 2014

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