Use of Deep Brain Stimulation in the treatment of neuropathic pain after stroke

Ana Flávia Assis¹, Gilcielma Lemos², Letícia Escorse¹, Roberta Costa³, João Gustavo Morais¹, Luís Emanuel², Pedro Lucca Bastos¹.

1.Medicine students at Bahiana School of Medicine and Public Health; 2.Medicine students at Federal University of Bahia; 3.Medicine student of University San Salvador.

OBJECTIVE: Analyze the effectiveness of deep brain stimulation (DBS) in the treatment of neuropathic pain after stroke.

METHODS: This is a literature review based on the analysis of observational studies, clinical trials and meta-analysis. The present study used articles published between 2005 and 2018, which were searched in the PubMed database. The descriptors used were "deep brain stimulation", "stroke", "pain" and "treatment". After reading the abstract, articles that did not match to the purpose of this review were excluded.

RESULTS: According to the search strategies, 28 articles were found, of which 13 attended to the eligibility criteria. In a meta-analysis (Bittar et al., 2005) deep brain stimulation proved to be more effective for the treatment of nociceptive pain compared to the treatment of neuropathic pain, with a difference of 67% to 43% regarding to the success of long-term treatment. In a randomized double-blind clinical trial (Lempka et al., 2017) conducted with 9 patients, there was an improvement in the affective component of pain, such as depression and anxiety, with DBS, and 5 participants decided to continue with this treatment after the study.

CONCLUSIONS: The treatment for neuropathic pain after stroke remains challenging, since the studies carried out on the use of DBS do not provide sufficient evidence and randomized, double-blind, placebo controlled clinical trials with a larger sample size need to be conducted to prove the effectiveness and safety of its use in clinical practice.

KEYWORDS: Deep Brain Stimulation; Neuropathic Pain; Stroke