TY - JOUR

T1 - Deep brain stimulation as a treatment for neuropathic pain

T2 - a longitudinal study addressing neuropsychological outcomes

AU - Gray, Alan

AU - Pounds-Cornish, Elizabeth

AU - Eccles, Fiona

AU - Aziz, Tipu

AU - Green, Alexander

AU - Scott, Richard B

PY - 2014/3

Y1 - 2014/3

N2 - Deep Brain Stimulation (DBS) of the periventricular/periaqueductal grey (PVG/PAG) area and sensory thalamus (ST) can reduce pain intensity in patients with neuropathic pain. However, little is known about its impact on quality of life, emotional well-being, and cognition. This study followed up 18 patients who had received DBS for neuropathic pain. Each participant had previously undergone psychometric evaluation of each of the above areas as part of a routine pre-surgical neuropsychological assessment. Commensurate measures were employed at a follow-up assessment at least 6 months post-surgery. DBS significantly improved mood, anxiety, and aspects of quality of life. Improvements correlated with reduced pain severity. However, the sample continued to show impairments in most areas when compared against normative data published on non-clinical samples. There was little change in general cognitive functioning, aside from deterioration in spatial working memory. However, improvements in pain severity were associated with less improvement (and even deterioration) on measures of executive cognitive functioning. Improvements in emotional well-being also correlated with changes in cognition. These results suggest that DBS of the PVG/PAG and/or ST improves quality of life and emotional well-being in sufferers, although there is some indication of executive dysfunction particularly amongst those reporting greatest pain alleviation.

AB - Deep Brain Stimulation (DBS) of the periventricular/periaqueductal grey (PVG/PAG) area and sensory thalamus (ST) can reduce pain intensity in patients with neuropathic pain. However, little is known about its impact on quality of life, emotional well-being, and cognition. This study followed up 18 patients who had received DBS for neuropathic pain. Each participant had previously undergone psychometric evaluation of each of the above areas as part of a routine pre-surgical neuropsychological assessment. Commensurate measures were employed at a follow-up assessment at least 6 months post-surgery. DBS significantly improved mood, anxiety, and aspects of quality of life. Improvements correlated with reduced pain severity. However, the sample continued to show impairments in most areas when compared against normative data published on non-clinical samples. There was little change in general cognitive functioning, aside from deterioration in spatial working memory. However, improvements in pain severity were associated with less improvement (and even deterioration) on measures of executive cognitive functioning. Improvements in emotional well-being also correlated with changes in cognition. These results suggest that DBS of the PVG/PAG and/or ST improves quality of life and emotional well-being in sufferers, although there is some indication of executive dysfunction particularly amongst those reporting greatest pain alleviation.

KW - chronic pain

KW - neuropathic pain

KW - deep brain stimulation

KW - cognition

KW - mood

U2 - 10.1016/j.jpain.2013.11.003

DO - 10.1016/j.jpain.2013.11.003

M3 - Journal article

VL - 15

SP - 283

EP - 292

JO - The Journal of Pain

JF - The Journal of Pain

SN - 1526-5900

IS - 3

ER -