Deep Brain Stimulation and Motor Cortical Stimulation for Malignant Pain

  • Joshua M. RosenowEmail author
  • Jonathan Miller


Neurostimulation has been used for decades to treat refractory pain. Deep brain stimulation was one of the earliest techniques used for this. More recently, the 1990s saw the beginning of epidural motor cortical stimulation for chronic pain. Both treatments have checkered histories. This chapter reviews these procedures and discusses the technique and outcomes from each of them.


Chronic pain Motor cortex stimulation Deep brain stimulation Neuropathic pain Malignant pain 


  1. 1.
    Olds J, Milner P. Positive reinforcement produced by electrical stimulation of septal area and other regions of rat brain. J Comp Physiol Psychol. 1954;47(6):419–27. PubMed PMID: 13233369.CrossRefGoogle Scholar
  2. 2.
    Reynolds DV. Surgery in the rat during electrical analgesia induced by focal brain stimulation. Science. 1969;164(878):444–5. PubMed PMID: 4887743.CrossRefGoogle Scholar
  3. 3.
    Heath RG, Mickle WA. Evaluation of seven years’ experience with depth electrode studies in human patients. In: Ramey ER, O’Doherty DS, editors. Electrical studies on the unanesthetized brain, vol. 1. New York: Paul B Hoeber; 1960. p. 214–28.Google Scholar
  4. 4.
    Gol A. Relief of pain by electrical stimulation of the septal area. J Neurol Sci. 1967;5(1):115–20. PubMed PMID: 6061755.CrossRefGoogle Scholar
  5. 5.
    Hosobuchi Y. Subcortical electrical stimulation for control of intractable pain in humans. Report of 122 cases (1970–1984). J Neurosurg. 1986;64(4):543–53. PubMed PMID: 3485191.CrossRefGoogle Scholar
  6. 6.
    Richardson DE, Akil H. Long term results of periventricular gray self-stimulation. Neurosurgery. 1977;1(2):199–202. PubMed PMID: 308192.CrossRefGoogle Scholar
  7. 7.
    Adams JE, Hosobuchi Y, Fields HL. Stimulation of internal capsule for relief of chronic pain. J Neurosurg. 1974;41(6):740–4. PubMed PMID: 4609304.CrossRefGoogle Scholar
  8. 8.
    Thoden U, Doerr M, Dieckmann G, Krainick JU. Medial thalamic permanent electrodes for pain control in man: an electrophysiological and clinical study. Electroencephalogr Clin Neurophysiol. 1979;47(5):582–91. PubMed PMID: 91485.CrossRefGoogle Scholar
  9. 9.
    Lende RA, Kirsch WM, Druckman R. Relief of facial pain after combined removal of precentral and postcentral cortex. J Neurosurg. 1971;34(4):537–43. PubMed PMID: 5554359.CrossRefGoogle Scholar
  10. 10.
    Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Treatment of thalamic pain by chronic motor cortex stimulation. Pacing Clin Electrophysiol. 1991;14(1):131–4. PubMed PMID: 1705329.CrossRefGoogle Scholar
  11. 11.
    Wallace JM. Update on pharmacotherapy guidelines for treatment of neuropathic pain. Curr Pain Headache Rep. 2007;11(3):208–14. PubMed PMID: 17504648.CrossRefGoogle Scholar
  12. 12.
    Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg. 2009;110(2):251–6. PubMed PMID: 18991496.CrossRefGoogle Scholar
  13. 13.
    Lima MC, Fregni F. Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature. Neurology. 2008;70(24):2329–37. PubMed PMID: 18541887.CrossRefGoogle Scholar
  14. 14.
    Young R, Rinaldi P. Brain stimulation. In: Levy RM, North RB, editors. Neurosurgical management of pain, vol. 1. New York: Springer-Verlag; 1996. p. 65–83.Google Scholar
  15. 15.
    Levy R, Deer TR, Henderson J. Intracranial neurostimulation for pain control: a review. Pain Physician. 2010;13(2):157–65. PubMed PMID: 20309382.PubMedGoogle Scholar
  16. 16.
    Coffey RJ. Deep brain stimulation for chronic pain: results of two multicenter trials and a structured review. Pain Med. 2001;2(3):183–92. PubMed PMID: 15102250.CrossRefGoogle Scholar
  17. 17.
    Hamani C, Schwalb JM, Rezai AR, Dostrovsky JO, Davis KD, Lozano AM. Deep brain stimulation for chronic neuropathic pain: long-term outcome and the incidence of insertional effect. Pain. 2006;125(1–2):188–96. PubMed PMID: 16797842.CrossRefGoogle Scholar
  18. 18.
    Levy RM, Lamb S, Adams JE. Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature. Neurosurgery. 1987;21(6):885–93. PubMed PMID: 3325851.CrossRefGoogle Scholar
  19. 19.
    Mundinger F, Salomao JF. Deep brain stimulation in mesencephalic lemniscus medialis for chronic pain. Acta Neurochir Suppl (Wien). 1980;30:245–58. PubMed PMID: 7008520.CrossRefGoogle Scholar
  20. 20.
    Boccard SG, Pereira EA, Moir L, Aziz TZ, Green AL. Long-term outcomes of deep brain stimulation for neuropathic pain. Neurosurgery. 2013;72(2):221–30. discussion 31. PubMed PMID: 23149975.CrossRefGoogle Scholar
  21. 21.
    Previnaire JG, Nguyen JP, Perrouin-Verbe B, Fattal C. Chronic neuropathic pain in spinal cord injury: efficiency of deep brain and motor cortex stimulation therapies for neuropathic pain in spinal cord injury patients. Ann Phys Rehabil Med. 2009;52(2):188–93. PubMed PMID: 19909709.CrossRefGoogle Scholar
  22. 22.
    Bittar RG, Otero S, Carter H, Aziz TZ. Deep brain stimulation for phantom limb pain. J Clin Neurosci. 2005;12(4):399–404. PubMed PMID: 15925769.CrossRefGoogle Scholar
  23. 23.
    Owen SL, Green AL, Stein JF, Aziz TZ. Deep brain stimulation for the alleviation of post-stroke neuropathic pain. Pain. 2006;120(1–2):202–6. PubMed PMID: 16359796.CrossRefGoogle Scholar
  24. 24.
    Boccard SG, Pereira EA, Moir L, Van Hartevelt TJ, Kringelbach ML, FitzGerald JJ, et al. Deep brain stimulation of the anterior cingulate cortex: targeting the affective component of chronic pain. Neuroreport. 2014;25(2):83–8. PubMed PMID: 24100411.CrossRefGoogle Scholar
  25. 25.
    Garcia-Larrea L, Peyron R. Motor cortex stimulation for neuropathic pain: from phenomenology to mechanisms. NeuroImage. 2007;37(Suppl 1):S71–9. PubMed PMID: 17644413.CrossRefGoogle Scholar
  26. 26.
    Peyron R, Faillenot I, Mertens P, Laurent B, Garcia-Larrea L. Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study. NeuroImage. 2007;34(1):310–21. PubMed PMID: 17055297.CrossRefGoogle Scholar
  27. 27.
    Pirotte B, Voordecker P, Brotchi J, Levivier M. Anatomical and physiological basis, clinical and surgical considerations, mechanisms underlying efficacy and future prospects of cortical stimulation for pain. Acta Neurochir Suppl. 2007;97(Pt 2):81–9. PubMed PMID: 17691293.CrossRefGoogle Scholar
  28. 28.
    Canavero S, Bonicalzi V. Extradural cortical stimulation for central pain. Acta Neurochir Suppl. 2007;97(Pt 2):27–36. PubMed PMID: 17691286.CrossRefGoogle Scholar
  29. 29.
    Lazorthes Y, Sol JC, Fowo S, Roux FE, Verdie JC. Motor cortex stimulation for neuropathic pain. Acta Neurochir Suppl. 2007;97(Pt 2):37–44. PubMed PMID: 17691287.CrossRefGoogle Scholar
  30. 30.
    Holsheimer J, Lefaucheur JP, Buitenweg JR, Goujon C, Nineb A, Nguyen JP. The role of intra-operative motor evoked potentials in the optimization of chronic cortical stimulation for the treatment of neuropathic pain. Clin Neurophysiol. 2007;118(10):2287–96. PubMed PMID: 17765605.CrossRefGoogle Scholar
  31. 31.
    Nuti C, Peyron R, Garcia-Larrea L, Brunon J, Laurent B, Sindou M, et al. Motor cortex stimulation for refractory neuropathic pain: four year outcome and predictors of efficacy. Pain. 2005;118(1–2):43–52. PubMed PMID: 16214292.CrossRefGoogle Scholar
  32. 32.
    Lefaucheur JP, Drouot X, Cunin P, Bruckert R, Lepetit H, Creange A, et al. Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain. Brain. 2009;132(Pt 6):1463–71. PubMed PMID: 19336459.CrossRefGoogle Scholar
  33. 33.
    Sachs AJ, Babu H, Su YF, Miller KJ, Henderson JM. Lack of efficacy of motor cortex stimulation for the treatment of neuropathic pain in 14 patients. Neuromodulation. 2014;17(4):303–11. PubMed PMID: 24773411.CrossRefGoogle Scholar
  34. 34.
    Zaghi S, Heine N, Fregni F. Brain stimulation for the treatment of pain: a review of costs, clinical effects, and mechanisms of treatment for three different central neuromodulatory approaches. J Pain Manag. 2009;2(3):339–52. PubMed PMID: 20585474. Pubmed Central PMCID: 2888303.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Henderson JM, Boongird A, Rosenow JM, LaPresto E, Rezai AR. Recovery of pain control by intensive reprogramming after loss of benefit from motor cortex stimulation for neuropathic pain. Stereotact Funct Neurosurg. 2004;82(5–6):207–13. PubMed PMID: 15583465. Epub 2004/12/08. eng.CrossRefGoogle Scholar
  36. 36.
    Delavallee M, Rooijakkers H, Koerts G, Raftopoulos C. Motor cortex stimulation in a three-year-old child with trigeminal neuropathic pain caused by a malignant glioma in the cerebellopontine angle: case report. Neurosurgery. 2011;69(2):E494–6. PubMed PMID: 21792145.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Northwestern Memorial Hospital, Department of Neurosurgery, Neurology and Physical Medicine and RehabilitationChicagoUSA
  2. 2.University Hospitals Case Medical Center, Case Western Reserve UniversityClevelandUSA

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