Brain Electrode Implant Prescription for Back Pain NEW YORK (Reuters) -- An electrode implanted deep in the brain to deliver a small electric current may relieve people with unbearable pain that does not respond to any other treatment, a study shows. Neurosurgeons in Canada say deep brain stimulation (DBS) offers safe and effective long-term pain control for patients with unremitting back pain or certain other chronic pain problems, including nerve pain. The study found a 62% success rate in 68 patients treated with DBS over 15 years. Most of the patients suffered from "failed back syndrome," meaning they had relentless back pain that remained unimproved or was made even worse by surgery. According to researchers led by Krishna Kumar of the University of Saskatchewan's Section on Neurosurgery in Regina, Canada, the DBS success rate in this back pain group was 74%. The procedure involves surgery to place a tiny, platinum alloy electrode in a specific location in the brain's gray matter. A small electric current -- one to eight volts -- is then put through the electrode via external leads to stimulate the tissue. The patient is awake during the operation. One of several brain sites may be chosen for electrode placement, depending on the pain response. When pain and swelling from the implant incision subsides (usually within three days), the patient is given a trial period of stimulation that lasts five to seven days. During this trial, patients individually control the amount, duration, and frequency of stimulation, based on their pain levels and the relief obtained. If patients report the trial period of DBS reduces pain by more than half, another operation is performed in which a tiny capsule containing a generator is permanently implanted under the skin near the collarbone. The generator is computer programmed to deliver specific levels and amounts of stimulation through a remote transmitter operated by the patient. According to the researchers, 53 patients had a generator implanted after a successful trial period. An average of more than six years later, 79% were still getting adequate pain relief from DBS. Along with success in treating back pain, some patients with certain types of nerve pain had good results (including those with facial and other pain related to the trigeminal nerve). But DBS was not as effective for people whose pain was caused by spinal cord injury. Moreover, Kumar and his colleagues note that DBS may wear off over time. This may be remedied by an operation to implant another electrode in a different part of the brain. So far, very few serious complications associated with DBS have been reported. "One complication that has been previously underreported and overlooked is the development of migraine-like headaches in 20% to 25% of patients," the researchers point out. Since the 1970s, DBS has been used in many countries around the world. Currently, it is not federally approved for use in the U.S. where it is considered an experimental procedure and, therefore, is not covered by health insurance. SOURCE: Neurosurgery (1997;40(4):736-746)
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