gms | German Medical Science

Objective: The treatment of patients with chronic pain syndromes is an ongoing problem in daily medical practice of multiple specialized clinicians. In many cases pharmacological and standard procedures are ineffective or accompanied with intolerable side effects. In a selected patient sample invasive methods are optional for different neuropathic pain syndromes. A patient sample and the current significance of epidural motor cortex stimulation (MCS) are presented and discussed.

Methods: Current publications regarding the topics were searched by medline and Cochrane database. Additionally the patient sample of the authors was evaluated retrospectively.

Results: The best results are reported for patients with chronic neuropathic pain of the trigeminal nerve (TNP) and following plexus injury (brachial plexus injury = BPI). In selected cases of central pain syndromes after stroke (post stroke pain = PSP) or ischemic lesion in the thalamic nuclei positive effect was documented. In our own patient sample 11/16 patients with TNP, 4/11 with PSP and 4/4 with BPL were positively treated and pain reduction of more than 30% in a double-blinded testing phase was achieved.

Conclusions: Epidural MCS is a safe and effective treatment option for patients with chronic neuropathic pain who are insufficiently treated pharmacologically. This operation should only be offered in neurosurgical pain centres using standardized protocols and double-blinded testing. Patients with neuropathic pain following trigeminal nerve injury, brachial plexus injury or phantom limb pain seem to profit best from this method. The need for prospective trials to gain more experience with MCS and also other invasive pain treatments must be underlined.