The Influence of Etiology and Stimulation Target on the Outcome of Deep Brain Stimulation for Chronic Neuropathic Pain: A Systematic Review and Meta-Analysis

Dengyu Wang; Yang Lu; Yan Han; Xiaolei Zhang; Sheng Dong; Huifang Zhang; Guoqin Wang; Guihuai Wang; James Jin Wang

doi:10.1016/j.neurom.2022.12.002

The Influence of Etiology and Stimulation Target on the Outcome of Deep Brain Stimulation for Chronic Neuropathic Pain: A Systematic Review and Meta-Analysis

Neuromodulation. 2024 Jan;27(1):83-94. doi: 10.1016/j.neurom.2022.12.002. Epub 2023 Jan 24.

Authors

Dengyu Wang¹, Yang Lu², Yan Han¹, Xiaolei Zhang³, Sheng Dong³, Huifang Zhang³, Guoqin Wang³, Guihuai Wang³, James Jin Wang⁴

Affiliations

¹ School of Medicine, Tsinghua University, Beijing, China; Institute for Precision Medicine, Tsinghua University, Beijing, China.
² Institute for Precision Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
³ Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
⁴ Institute for Precision Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China. Electronic address: wja01068@btch.edu.cn.

PMID: 36697341
DOI: 10.1016/j.neurom.2022.12.002

Abstract

Objectives: Deep brain stimulation (DBS) to treat chronic neuropathic pain has shown variable outcomes. Variations in pain etiologies and DBS targets are considered the main contributing factors, which are, however, underexplored owing to a paucity of patient data in individual studies. An updated meta-analysis to quantitatively assess the influence of these factors on the outcome of DBS for chronic neuropathic pain is warranted, especially considering that the anterior cingulate cortex (ACC) has emerged recently as a new DBS target.

Materials and methods: A comprehensive literature review was performed in PubMed, Embase, and Cochrane data bases to identify studies reporting quantitative outcomes of DBS for chronic neuropathic pain. Pain and quality of life (QoL) outcomes, grouped by etiology and DBS target, were extracted and analyzed (α = 0.05).

Results: Twenty-five studies were included for analysis. Patients with peripheral neuropathic pain (PNP) had a significantly greater initial stimulation success rate than did patients with central neuropathic pain (CNP). Both patients with CNP and patients with PNP with definitive implant, regardless of targets, gained significant follow-up pain reduction. Patients with PNP had greater long-term pain relief than did patients with CNP. Patients with CNP with ACC DBS gained less long-term pain relief than did those with conventional targets. Significant short-term QoL improvement was reported in selected patients with CNP after ACC DBS. However, selective reporting bias was expected, and the improvement decreased in the long term.

Conclusions: Although DBS to treat chronic neuropathic pain is generally effective, patients with PNP are the preferred population over patients with CNP. Current data suggest that ACC DBS deserves further investigation as a potential way to treat the affective component of chronic neuropathic pain.

Keywords: Anterior cingulate cortex; deep brain stimulation; meta-analysis; neuropathic pain; quality of life.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Deep Brain Stimulation*
Gyrus Cinguli / physiology
Humans
Neuralgia* / etiology
Neuralgia* / therapy
Pain Management
Quality of Life
Treatment Outcome