Long-Term Results of Deep Brain Stimulation of the Anterior Cingulate Cortex for Neuropathic Pain

Background Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) is a recent technique that has shown some promising short-term results in patients with chronic refractory neuropathic pain. Three years after the first case series, we assessed its efficacy on a larger cohort, with longer follow-up. Methods Twenty-four patients (19 males; average age, 49.1 years) with neuropathic pain underwent bilateral ACC DBS. Patient-reported outcome measures were collected before and after surgery, using the Numerical Rating Scale (NRS), Short-Form 36 quality of life (SF-36), McGill Pain Questionnaire (MPQ), and EuroQol 5-domain quality of life (EQ-5D) questionnaire. Results Twenty-two patients after a trial week were fully internalized and 12 had a mean follow-up of 38.9 months. Six months after surgery the mean NRS score decreased from 8.0 to 4.27 ( P  = 0.004). There was a significant improvement in the MPQ (mean, −36%; P  = 0.021) and EQ-5D score significantly decreased (mean, −21%; P  = 0.036). The physical functioning domain of SF-36 was significantly improved (mean, +54.2%; P  = 0.01). Furthermore, in 83% of these patients, at 6 months, NRS score was improved by 60% ( P P P P  = 0.05) and significant improvements were also observed for different domains of the SF-36. At longer follow-ups, efficacy was sustained up to 42 months in some patients, with an NRS score as low as 3. Conclusions Follow-up results confirm that ACC DBS alleviates chronic neuropathic pain refractory to pharmacotherapy and improves quality of life in many patients.