Targeting the Affective Component of Chronic Pain: A Case Series of Deep Brain Stimulation of the Anterior Cingulate Cortex
Targeting the Affective Component of Chronic Pain: A Case Series of Deep Brain Stimulation of the Anterior Cingulate Cortex
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DOI：
10.1227/neu.0000000000000321
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发表时间：
2014-06-01
期刊：
影响因子：
4.8
通讯作者：
Aziz, Tipu Z.
中科院分区：
文献类型：
--
作者：
Boccard, Sandra G. J.;Fitzgerald, James J.;Aziz, Tipu Z.
背景：脑深部电刺激（DBS）在缓解难治性慢性疼痛的伤害性和神经性症状方面显示出相当大的前景。然而，对于一些患者，标准DBS治疗疼痛的效果仍然很差。疼痛是一种多维度的体验，其中包含情感成分：不愉快。前扣带皮层（ACC）是一个结构，参与了这一情感成分，并针对它可能会减轻患者的pains.Objective：描述ACC DBS的第一个案例系列，以减轻慢性神经病理性pains.METHODS的情感成分：16例（13男3女患者）与神经病理性疼痛进行双边ACC DBS。手术时的平均年龄为48.7岁（范围：33-63岁）。患者报告的结果的措施，收集手术前和手术后使用视觉模拟量表，SF-36生活质量调查，麦吉尔疼痛问卷，EQ-5D（EQ-5D和EQ-5D健康状态）questionnaire.RESULTS：15例（93.3%）从外化过渡到完全内化的系统。11例患者的数据有待分析，平均随访时间为13.2个月。术后，5例患者的视觉模拟量表评分降至4分以下，1例患者无疼痛。观察到EQ-5D的高度显著改善（平均值，120.3%;范围，10%-183%; P = 0.008）。此外，SF-36生活质量调查的身体功能和身体疼痛领域观察到统计学显着改善：平均值，164.7%（范围：28.9%-1276%; P = 0.015），平均139.0%结论：情感性ACC DBS可以缓解药物治疗无效的慢性神经病理性疼痛，恢复生活质量。
BACKGROUND: Deep brain stimulation (DBS) has shown considerable promise for relieving nociceptive and neuropathic symptoms of refractory chronic pain. Nevertheless, for some patients, standard DBS for pain remains poorly efficacious. Pain is a multidimensional experience with an affective component: the unpleasantness. The anterior cingulate cortex (ACC) is a structure involved in this affective component, and targeting it may relieve patients' pain.OBJECTIVE: To describe the first case series of ACC DBS to relieve the affective component of chronic neuropathic pain.METHODS: Sixteen patients (13 male and 3 female patients) with neuropathic pain underwent bilateral ACC DBS. The mean age at surgery was 48.7 years (range, 33-63 years). Patient-reported outcome measures were collected before and after surgery using a Visual Analog Scale, SF-36 quality of life survey, McGill Pain Questionnaire, and EQ-5D (EQ-5D and EQ-5D Health State) questionnaires.RESULTS: Fifteen patients (93.3%) transitioned from externalized to fully internalized systems. Eleven patients had data to be analyzed with a mean follow-up of 13.2 months. Post-surgery, the Visual Analog Scale score dropped below 4 for 5 of the patients, with 1 patient free of pain. Highly significant improvement on the EQ-5D was observed (mean, 120.3%; range, 10%-183%; P = .008). Moreover, statistically significant improvements were observed for the physical functioning and bodily pain domains of the SF-36 quality-of-life survey: mean, 164.7% (range, 28.9%-1276%; P = .015) and mean 139.0% (range, 233.8%-1159%; P = .050), respectively.CONCLUSION: Affective ACC DBS can relieve chronic neuropathic pain refractory to pharmacotherapy and restore quality of life.