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Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis

Despite available, advanced pharmacological and behavioral therapies, refractory chronic facial pain of different origins still poses a therapeutic challenge. In circumstances where there is insufficient responsiveness to pharmacological/behavioral therapies, deep brain stimulation should be conside...

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Autores principales: Qassim, Hebatallah, Zhao, Yining, Ströbel, Armin, Regensburger, Martin, Buchfelder, Michael, de Oliveira, Daniela Souza, Del Vecchio, Alessandro, Kinfe, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046035/
https://www.ncbi.nlm.nih.gov/pubmed/36979302
http://dx.doi.org/10.3390/brainsci13030492
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author Qassim, Hebatallah
Zhao, Yining
Ströbel, Armin
Regensburger, Martin
Buchfelder, Michael
de Oliveira, Daniela Souza
Del Vecchio, Alessandro
Kinfe, Thomas
author_facet Qassim, Hebatallah
Zhao, Yining
Ströbel, Armin
Regensburger, Martin
Buchfelder, Michael
de Oliveira, Daniela Souza
Del Vecchio, Alessandro
Kinfe, Thomas
author_sort Qassim, Hebatallah
collection PubMed
description Despite available, advanced pharmacological and behavioral therapies, refractory chronic facial pain of different origins still poses a therapeutic challenge. In circumstances where there is insufficient responsiveness to pharmacological/behavioral therapies, deep brain stimulation should be considered as a potential effective treatment option. We performed an individual participant data (IPD) meta-analysis including searches on PubMed, Embase, and the Cochrane Library (2000–2022). The primary endpoint was the change in pain intensity (visual analogue scale; VAS) at a defined time-point of ≤3 months post-DBS. In addition, correlation and regression analyses were performed to identify predictive markers (age, duration of pain, frequency, amplitude, intensity, contact configuration, and the DBS target). A total of seven trials consisting of 54 screened patients met the inclusion criteria. DBS significantly reduced the pain levels after 3 months without being related to a specific DBS target, age, contact configuration, stimulation intensity, frequency, amplitude, or chronic pain duration. Adverse events were an infection or lead fracture (19%), stimulation-induced side effects (7%), and three deaths (unrelated to DBS—from cancer progression or a second stroke). Although comparable long-term data are lacking, the current published data indicate that DBS (thalamic and PVG/PAG) effectively suppresses facial pain in the short-term. However, the low-quality evidence, reporting bias, and placebo effects must be considered in future randomized-controlled DBS trials for facial pain.
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spelling pubmed-100460352023-03-29 Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis Qassim, Hebatallah Zhao, Yining Ströbel, Armin Regensburger, Martin Buchfelder, Michael de Oliveira, Daniela Souza Del Vecchio, Alessandro Kinfe, Thomas Brain Sci Systematic Review Despite available, advanced pharmacological and behavioral therapies, refractory chronic facial pain of different origins still poses a therapeutic challenge. In circumstances where there is insufficient responsiveness to pharmacological/behavioral therapies, deep brain stimulation should be considered as a potential effective treatment option. We performed an individual participant data (IPD) meta-analysis including searches on PubMed, Embase, and the Cochrane Library (2000–2022). The primary endpoint was the change in pain intensity (visual analogue scale; VAS) at a defined time-point of ≤3 months post-DBS. In addition, correlation and regression analyses were performed to identify predictive markers (age, duration of pain, frequency, amplitude, intensity, contact configuration, and the DBS target). A total of seven trials consisting of 54 screened patients met the inclusion criteria. DBS significantly reduced the pain levels after 3 months without being related to a specific DBS target, age, contact configuration, stimulation intensity, frequency, amplitude, or chronic pain duration. Adverse events were an infection or lead fracture (19%), stimulation-induced side effects (7%), and three deaths (unrelated to DBS—from cancer progression or a second stroke). Although comparable long-term data are lacking, the current published data indicate that DBS (thalamic and PVG/PAG) effectively suppresses facial pain in the short-term. However, the low-quality evidence, reporting bias, and placebo effects must be considered in future randomized-controlled DBS trials for facial pain. MDPI 2023-03-14 /pmc/articles/PMC10046035/ /pubmed/36979302 http://dx.doi.org/10.3390/brainsci13030492 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Qassim, Hebatallah
Zhao, Yining
Ströbel, Armin
Regensburger, Martin
Buchfelder, Michael
de Oliveira, Daniela Souza
Del Vecchio, Alessandro
Kinfe, Thomas
Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis
title Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis
title_full Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis
title_fullStr Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis
title_full_unstemmed Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis
title_short Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis
title_sort deep brain stimulation for chronic facial pain: an individual participant data (ipd) meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046035/
https://www.ncbi.nlm.nih.gov/pubmed/36979302
http://dx.doi.org/10.3390/brainsci13030492
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