gms | German Medical Science

Objective: Chronic pain syndromes pose specific problems for treatment. Motor cortex stimulation has evolved since its introduction in the 1990s as an alternative therapeutical option mainly in central pain but also other conditions such as facial pain syndromes. We evaluated the long-term outcome of chronic pain patients treated with motor cortex stimulation in our institution.

Method: Nine patients with chronic pain syndromes involving the face or arm underwent epidural implantation of one or two paddle electrodes (ResumeII) under general anesthesia orthogonal to the central sulcus over the area of the homunculus of the affected part of the body by using functional MRI, neuronavigation and intraoperative electrophysiology. Electrodes were externalised for four days for test stimulation. Patients then had a second procedure for implantation of a pacemaker in the subclavicular/ subcutaneous tissue. Intensity of pain was assessed by a visual analogue sccale.

Results: There were 5 men and 4 women. In seven patients the electrodes were connected to a pacemaker. Mean age at surgery was 56.5 years (range, 23 - 80 years). There were no surgical related complications. Two patients were classified as non responders. Mean follow-up was 24 months (10 - 54). Mean improvement of pain in responders was 50% on the VAS at long-term follow-up. Patients with facial pain syndromes had greater benefit than patients with pain in the upper extremities.

Conclusions: Motor cortex stimulation is a valuable treatment option in patients with otherwise untreatable chronic pain syndromes. Criteria for patient selection still need to be elaborated.