Deep brain stimulation of the ventral anterior limb of the internal capsule for m

描述(由申请人提供) 摘要：慢性神经性疼痛是致残的常见原因之一。对于患有药物难治性神经性疼痛的患者，大多数治疗方案，如脊髓刺激、丘脑深部脑刺激或鞘内注射麻醉药，都旨在产生止痛，已知疗效有限。我们提出了一种基于神经调节的创新方法来治疗中央丘脑疼痛综合征，这是一种特别严重的神经病理性疼痛，其特征是由于丘脑感觉通路的损伤而导致无情的麻醉疼痛。我们偏离了传统的目标，即干预痛觉传递的感觉辨别性神经通路，以产生止痛。相反，我们计划以深部脑刺激(DBS)为目标，目标是内囊前肢(ALIC)的腹侧区域，该区域密集分布着与行为和情绪控制相关的神经网络。通过电刺激这些网络，我们期望调节患有其他顽固性疼痛的患者的情感范围，从而减少与疼痛相关的残疾。我们假设，与调节情感疼痛范围相关的疼痛相关残疾的改善将不依赖于止痛效果。为此，视觉模拟评分将被用作控制疼痛水平和止痛的次要结果衡量标准，但该研究的主要结果衡量标准将是疼痛残疾指数。参加这项研究的患者将接受为期六个月的基线和DBS后双盲评估，然后进行慢性开放标签刺激。情绪控制的神经回路和DBS对这些网络的影响将定期通过功能磁共振成像和脑磁图进行研究。 公共卫生相关性：慢性神经性疼痛在人群中非常常见，影响到参加家庭实践的8%的个人。在美国和其他国家，它是导致残疾的主要原因。尽管有几种治疗方案，但大部分慢性疼痛患者(高达50%)没有反应并保持残疾。在这项提案中，我们描述了一种创新的方法来减轻那些患有严重和难治性慢性神经性疼痛的人的痛苦和残疾。

DESCRIPTION (Provided by the applicant) Abstract: Chronic neuropathic pain is a common cause of disability in the population. Most treatment options for patients with medically refractory neuropathic pain, such as spinal cord stimulation, thalamic deep brain stimulation or intrathecal infusion of narcotics, are aimed at producing analgesia and are known to have limited efficacy. We propose an innovative neuromodulation-based approach to treat patients with central thalamic pain syndrome, a particularly severe form of neuropathic pain characterized by relentless anesthesia dolorosa resulting from injury to the thalamic sensory pathways. We depart from the traditional goal of intervening in the sensory discriminative neural pathways of pain transmission in order to produce analgesia. Instead, we plan to target with deep brain stimulation (DBS) the ventral area of the anterior limb of the internal capsule (ALIC), a region densely populated by fibers related to neural networks related to the control of behavior and emotion. By electrically stimulating these networks, we expect to modulate the affective sphere of patients with otherwise intractable pain and, consequently, reduce pain related disability. We hypothesize that the improvement in pain related disability associated with modulation of the affective pain sphere will not be dependent on analgesic effects. For this reason, the visual analog scale will be used as a secondary outcome measure to control for pain levels and analgesia but the primary outcome measure of the study will be the pain disability index. Patients enrolled in this research will undergo baseline and post-DBS double blinded evaluations for a period of six months, followed by chronic open label stimulation. The neural circuits of emotion control and the effects of DBS upon these networks will be studied at regular intervals with functional magnetic resonance imaging and magnetoencephalography. Public Health Relevance: Chronic neuropathic pain is very common in the population, affecting 8% of individuals enrolled in family practices. It is a leading cause of disability in the United States and other countries. Although several treatment options exist, large shares of patients with chronic pain (up to 50%) fail to respond and remain disabled. In this proposal, we describe an innovative approach to alleviate suffering and disability among those with severe and refractory chronic neuropathic pain.