Abstract
It is important and yet bothersome for physicians to treat neuropathic pain. Neuropathic pain can be caused by a number of different diseases (e.g., diabetes mellitus, herpes zoster, brachial plexus avulsion, complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS), spinal cord injury, post stroke central pain (CPSP), and multiple sclerosis). There are many medicines for neuropathic pain, however, pharmacological relief of neuropathic pain is often insufficient. In such cases, surgical intervention can be attempted. Ablative surgery procedures including thalamotomy and DREZtomy were formerly applied for patients with such intractable pain, while neuromodulation therapies including spinal cord stimulation (SCS), deep brain stimulation (DBS), motor cortex stimulation (MCS), peripheral nerve stimulation (PNS) and repetitive transcranial magnetic stimulation (rTMS) are used today. Spinal cord stimulation (SCS) is efficacious in FBSS and CRPS type I (level B recommendation). DBS could be efficacious in treating phantom pain, or brachial plexus avulsion. MCS is efficacious in CPSP and facial pain (level C). Evidence for implanted peripheral stimulation is inadequate. rTMS has transient efficacy in treating central and peripheral neuropathic pain (level B). Further controlled trials are warranted for SCS in conditions other than failed back surgery syndrome and CRPS and for MCS and DBS in general. These chronically implanted techniques provide satisfactory pain relief in many patients, including those resistant to medication or other means.
