Stimulation of Human Thalamus for Pain Relief: Possible Modulatory Circuits Revealed by Positron Emission Tomography

Gary H. Duncan 1 , 2 , 3 , Ron C. Kupers 2 , Serge Marchand 4 , 6 , Jean-Guy Villemure 3 , JAN M. Gybels 7 , and M. Catherine Bushnell 2 , 3 , 4 , 5 1 Département de stomatologie, Faculté de médecine dentaire and 2 Centre de recherche en sciences neurologiques, Université de Montréal, Montréal, Québec, Canada, H3C 3J7; 3 Department of Neurology and Neurosurgery, Faculty of Medicine, 4 Faculty of Dentistry, and 5 Department of Anesthesiology, Faculty of Medicine, McGill University, Montréal, Québec, Canada; and 6 Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada; and 7 Department of Neurology and Neurosurgery, University Hospital, Gasthuisberg, Louvain, Belgium Duncan, Gary H., Ron C. Kupers, Serge Marchand, Jean-Guy Villemure, Jan M. Gybels, and M. Catherine Bushnell. Stimulation of human thalamus for pain relief: possible modulatory circuits revealed by positron emission tomography . J. Neurophysiol. 80: 3326-3330, 1998. Stimulation of the somatosensory thalamus was used for more than 2 decades to treat chronic pain in the human. However, despite clinical reports of successful results, little is known about the actual mechanisms mediating this form of stimulation-produced analgesia. To reveal possible neuronal pathways evoked by thalamic stimulation, we measured regional changes in cerebral blood flow (rCBF) in five patients who received successful long-term relief of chronic pain with somatosensory thalamic stimulation. Positron emission tomography during thalamic stimulation revealed significant activation of the thalamus in the region of the stimulating electrodes as well as activation of the insular cortex ipsilateral to the thalamic electrodes (contralateral to the patients' clinical pain). For these patients, thalamic stimulation also evoked paresthesiae that included thermal sensations in addition to tingling sensations. Results of this study indicate that in some cases somatosensory thalamic stimulation may activate a thalamocortical pain modulation circuit that involves thermal pathways. These results are consistent with other recent reports suggesting that activation of thermal pathways may contribute to modulation of nociceptive information.