From the Research
Deep Brain Stimulation (DBS) should only be considered for the treatment of Central Thalamic Pain Syndrome after failure of comprehensive conservative management, due to its experimental nature and variable success rates, as evidenced by the most recent and highest quality study available 1. The evidence for DBS in treating Central Thalamic Pain Syndrome is limited and inconsistent, with success rates varying widely across studies, ranging from 25% to 70% pain reduction in selected patients, with many experiencing diminishing effects over time 1. Some key points to consider when evaluating DBS for Central Thalamic Pain Syndrome include:
- Patient selection is critical, with better outcomes generally seen in those with neuropathic rather than nociceptive pain, shorter pain duration, and absence of psychological comorbidities 2, 1.
- The procedure carries significant risks including hemorrhage, infection, hardware complications, and neurological side effects 1, 3.
- The mechanism of action likely involves modulation of pain processing pathways through electrical disruption of abnormal neural activity 4, 5.
- DBS involves surgically implanting electrodes into specific brain regions, typically the periventricular/periaqueductal gray matter, sensory thalamus, or motor cortex, which are then connected to an implanted pulse generator that delivers electrical stimulation 2, 1. Given these considerations, patients should undergo thorough psychological evaluation and trial stimulation before permanent implantation, and have realistic expectations about potential benefits and limitations 1. It is also important to note that DBS may provide more insight into the functional anatomy of the thalamus, which used to be available only from animal studies, as highlighted in a case study where DBS was used to treat thalamic tremor in a patient with post-stroke chronic central pain 5.