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Cited by 259Pain Management and TreatmentDeep Brain Stimulation and Movement DisordersPain Mechanisms and Treatments

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Motor cortex stimulation for neuropathic pain: From phenomenology to mechanisms

Garcia-Larrea, Luis, Peyron, Roland·2007·NeuroImage
DOI 10.1016/j.neuroimage.2007.05.062
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Abstract

Motor cortex stimulation (MCS) is relatively recent neurosurgical technique for pain control, the use of which is growing steadily since its description in the last decade. While clinical series show that at least 50% of patients with chronic, pharmacoresistant neuropathic pain may benefit from this technique, the mechanisms of action of MCS remain elusive. In this review, we synthesise a number of studies that, combining electrophysiology and functional imaging, have permitted to proceed from phenomenology to models that may account for part of such mechanisms. MCS appears to trigger rapid and phasic activation in the lateral thalamus, which leads to a cascade of events of longer time-course in medial thalamus, anterior cingulate/orbitofrontal cortices and periaqueductal grey matter. Activity in these latter structures is delayed relative to actual cortical neurostimulation and becomes maximal during the hours that follow MCS arrest. Current hypotheses suggest that MCS may act through at least two mechanisms: activation of perigenual cingulate and orbitofrontal areas may modulate the emotional appraisal of pain, rather than its intensity, while top down activation of brainstem PAG may lead to descending inhibition toward the spinal cord. Recent evidence also points to a possible secretion of endogenous opioids triggered by chronic MCS. This, along with the delayed and long-lasting activation of several brain structures, is consistent with the clinical effects of MCS, which m…

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Metadata

Authors
Garcia-Larrea, L., & Peyron, R.
Affiliations
Inserm (FR)
ORCID
Peyron, Roland
Venue
NeuroImage
Publisher
Elsevier BV
Published
2007
Volume
37
Pages
S71-S79
ISSN
1053-8119 (ISSN-L)
DOI
10.1016/j.neuroimage.2007.05.062
OpenAlex
W2029045410
Cited by
259
References
75
Citations by year
2026: 8 · 2025: 4 · 2024: 12 · 2023: 13 · 2022: 15 · 2021: 20 · 2020: 14 · 2019: 18 · 2018: 11 · 2017: 11 · 2016: 17 · 2015: 21 · 2014: 16 · 2013: 13 · 2012: 15
FWCI
2.15
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • NeuroImage (publishedVersion)
  • PubMed (publishedVersion)
Funders
Fondation pour la Recherche Médicale
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
  • Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
Keywords
motor cortex stimulation, neuropathic pain, chronic pain, mechanism of action, lateral thalamus, medial thalamus, periaqueductal gray, anterior cingulate cortex, orbitofrontal cortex, descending pain inhibition, endogenous opioids, pain management
MeSH terms
Animals, Cerebrovascular Circulation, Chronic Disease, Endorphins, Humans, Magnetic Resonance Imaging, Motor Cortex, Pain, Peripheral Nervous System Diseases, Neurosurgical Procedures, Positron-Emission Tomography, Pain Management

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