Deep Brain Stimulation for the Treatment of Pain in the Rehabilitation Patient

Deep brain stimulation (DBS) has been used off-label to treat chronic, neuropathic, or nociceptive pain for decades; however, the precise mechanism of action remains elusive. In the absence of a standardized treatment algorithm, targets are determined based on the characteristics of pain presentation. The majority of studies to date have been case series focusing on stimulation of the sensory thalamus (ST) and periventricular/periaqueductal gray area (PVG/PAG) to successfully treat a wide range of chronic pain conditions, although several other deep brain structures have also been targeted. The treatment is associated with a relatively low-risk profile, with intracranial hemorrhage being the most potentially serious adverse event. Further research is necessary to better understand a number of issues, including the relationships between pathophysiology and mechanism of action, as well as optimal stimulation targets and parameters.