Abstract
This manuscript is a review of the neurosurgical treatments available for intractable chronic pain including stimulation therapy. Stimulation therapy for chronic pain includes deep brain stimulation (DBS), electrical motor cortex stimulation (EMCS), repetitive transcranial magnetic stimulation (rTMS) and spinal cord stimulation (SCS). DBS is not popular as a treatment for chronic pain. EMCS was developed by Tsubokawa and its use has subsequently expanded all over the world. However, the procedure is invasive, and as a result the use of rTMS is overtaking EMCS today. SCS is a less invasive technique and is also quite popular. Failed back surgery is a good indication for SCS. Post-stroke pain is often very difficult to control by drugs alone, but 40% of post-stroke pain patients experience a 30% pain reduction with SCS. Therefore, when treating post-stroke pain, SCS is definitely worth a try. Lesioning the dorsal root entry zone (DREZotomy) powerfully reduces the shooting pain caused by root avulsion, but stimulation therapies usually fail in this regard.
When treating younger patients with peripheral pain, the presence of continuous pain and less motor and sensory disturbances all seem to be good indications for stimulation therapy including EMCS, rTMS and SCS, whereas the shooting pain caused by root avulsion seems best served by DREZotomy.
