Central pain is an expression of a primary or secondary lesion or dysfunction of central nervous system and represents a very difficult condition to treat. Often pharmacotherapy allows a benefit clinically important only in a limited number of patients and clinical use of some drugs is rendered problematic by their poor handling and tolerability. Intracranial neurostimulation represents a reversible method of functional neurosurgery, adaptable and free of major side effects, indicated in cases of intractable chronic pain when other conservative treatment modalities have been exhausted. Currently two types of intracranial neurostimulation are commonly used for control pain: deep brain stimulation (DBS) and motor cortex stimulation (MCS). The relief of pain with chronic electrical stimulation of deep sensory thalamic nuclei (DBS) was first reported by Mazars et al. and Hosobuchi et al. Although Europe and the United States over the past 20 years have been several interventions of deep brain stimulation for the treatment of chronic pain syndromes, this method over the years has been gradually replaced by less invasive as spinal cord stimulation, intrathecal infusion pumps and epidural cortical stimulation. Despite this trend, some conditions of chronic pain refractory to drugs still represent a valid indication. DBS may be employed for a number of nociceptive and neuropathic pain states, including cluster headaches, chronic low back pain, failed back surgery syndrome, peripheral neuropathic pain and facial deafferentation pain. Patients are selected for DBS for pain if they experienced chronic pain unresponsive to medical or surgical therapies over many years and to treatment administered during an admission to a pain clinic. Pain pathways are very complex and DBS can modulate these mechanisms of transmission. The first pathway is composed of the spinothalamic tracts connecting the dorsal horn of the spinal cord to the ventral nuclei of the thalamus which project to the somatosensory cortices. The second pathway consists of tracts connecting the spine to the thalamus through the brain stem and the limbic system. Studies on deep brain stimulation for chronic pain in humans increased in the last years, thanks to the efficacy reported in various aetiologies including phantom limb pain, brachial plexus injury, central poststroke pain, face pain, spinal injuries or failed back surgery syndrome.

Journal of Pain Management & Medicine is a world-wide peer-reviewed open-access journal which systematically documents several of key developments and medical advances taking place in the field of Pain Management all across the world.

Submit manuscript at www.walshmedicalmedia.com/submissions/pain-management-medicine.html or send as an e-mail attachment to the Editorial Office at painmanagement@eclinjournals.com

sincaptv.xyz iptv iptv al iptv sat?n al