Activation of the anterior cingulate cortex by thalamic stimulation in patients with chronic pain: a positron emission tomography study

J Neurosurg. 2000 Jan;92(1):64-9. doi: 10.3171/jns.2000.92.1.0064.


Object: Deep brain stimulation (DBS) of the sensory thalamus has been used to treat chronic, intractable pain. The goal of this study was to investigate the thalamocortical pathways activated during thalamic DBS.

Methods: The authors compared positron emission tomography (PET) images obtained before, during, and after DBS in five patients with chronic pain. Two of the five patients reported significant DBS-induced pain relief during PET scanning, and the remaining three patients did not report any analgesic effect of DBS during scanning. The most robust effect associated with DBS was activation of the anterior cingulate cortex (ACC). An anterior ACC activation was sustained throughout the 40 minutes of DBS, whereas a more posteriorly located ACC activation occurred at a delay after onset of DBS, although these activations were not dependent on the degree of pain relief reported during DBS. However, implications specific to the analgesic effect of DBS require further study of a larger, more homogeneous patient population. Additional effects of thalamic DBS were detected in motor-related regions (the globus pallidus, cortical area 4, and the cerebellum) and visual and association cortical areas.

Conclusions: The authors demonstrate that the ACC is activated during thalamic DBS in patients with chronic pain.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chronic Disease
  • Electric Stimulation Therapy*
  • Female
  • Gyrus Cinguli / diagnostic imaging*
  • Gyrus Cinguli / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Pain / diagnostic imaging*
  • Pain / physiopathology
  • Pain Management*
  • Thalamus / physiopathology*
  • Tomography, Emission-Computed*
  • Treatment Outcome