Deep Brain Stimulation of the Subgenual Cingulate Cortex for the Treatment of Chronic Low Back Pain

Alon Kashanian, Evangelia Tsolaki, Nader Pouratian, Ausaf A. Bari

Research output: Contribution to journalReview articlepeer-review

Abstract

Objectives: Despite converging basic scientific and clinical evidence of the link between chronic pain and depression, existing therapies do not often take advantage of this overlap. Here, we provide a critical review of the literature that highlights the intersection in brain networks between chronic low back pain (CLBP) and depression and discuss findings from previous deep brain stimulation (DBS) studies for pain. Based on a multidimensional model of pain processing and the connectivity of the subgenual cingulate cortex (SCC) with areas that are implicated in both CLBP and depression, we propose a novel approach to the treatment of CLBP using DBS of the SCC. Materials and Methods: A narrative review with literature assessment. Results: CLBP is associated with a shift away from somatosensory representation toward brain regions that mediate emotional processes. There is a high degree of overlap between these regions and those involved in depression, including the anterior cingulate cortex, medial prefrontal cortex, nucleus accumbens, and amygdala. Whereas targets sites from previous DBS trials for pain were not anatomically positioned to engage these areas and their associated networks, the SCC is structurally connected to all of these regions and as well as others involved in mediating sensory, cognitive, and affective processing in CLBP. Conclusions: CLBP and depression share a common underlying brain network interconnected by the SCC. Current data and novel technology provide an optimal opportunity to develop clinically effective trials of SCC DBS for CLBP.

Original languageEnglish (US)
JournalNeuromodulation
DOIs
StateAccepted/In press - 2021
Externally publishedYes

Keywords

  • Chronic low back pain
  • deep brain stimulation
  • depression
  • pain
  • subgenual cingulate cortex

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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