This leaflet aims to provide relevant and comprehensive information about cranial MR-guided focused ultrasound (MRgFUS) as a treatment option for chronic and therapy-resistant neuropathic pain. Please read this information carefully before discussing it with your healthcare provider.
What is Chronic Neuropathic Pain?
Chronic neuropathic pain is a debilitating condition characterized by persistent, often severe, and challenging-to-treat pain. It can result from various underlying causes, including nerve damage, spinal cord injury, post-surgery complications, and certain medical conditions.
Cranial MR-Guided Focused Ultrasound (MRgFUS)
Cranial MR-guided focused ultrasound (MRgFUS) is an innovative, non-invasive neurosurgical approach used to treat chronic neuropathic pain. This groundbreaking technique delivers precisely focused ultrasound waves to specific brain regions without the need for incisions or anaesthesia.
How Does MRgFUS Work?
Planning: Before the procedure, your healthcare team conducts a thorough evaluation and uses MRI scans to create a personalised treatment plan. This plan determines the exact location in your brain that requires treatment.
Treatment: During the MRgFUS procedure, you are positioned within an MRI scanner. High-intensity ultrasound waves are precisely focused on the targeted brain tissue to create a small lesion. This lesion disrupts the abnormal brain circuits responsible for chronic neuropathic pain.
Monitoring: The MRI scanner continuously monitors the procedure, allowing real-time adjustments to ensure precision and safety.
Advantages of MRgFUS for Chronic Neuropathic Pain
Non-invasive: MRgFUS eliminates the need for surgery or incisions, reducing the risks associated with traditional surgical treatments.
Precise: This technology enables accurate targeting of affected brain regions while sparing healthy tissue.
Rapid Recovery: Most patients can return to their normal activities within a few days to a week after the procedure.
No Radiation: MRgFUS uses MRI for guidance, eliminating exposure to ionising radiation.
Pain Management at Precision Brain Spine and Pain
At Precision Brain Spine and Pain, we are committed to providing comprehensive pain management solutions. Our approach is based on the following principles:
Multidisciplinary and Holistic Approach: We adopt a multidisciplinary, holistic, and evidence-based approach to pain management. Our goal is to address not only the physical aspects of pain but also its emotional and psychological impact on your well-being.
Personalised Treatment: We understand that every patient is unique. Therefore, we personalise and individualise treatment according to each patient’s clinical needs and expressed wishes. Your treatment plan is tailored to your specific condition and preferences.
Expert Team: Our extensive team of healthcare professionals includes neurosurgeons, pain specialists, rehabilitation physicians, neurologists, and occupational physicians. This collaborative approach ensures that you receive the highest quality care.
Leading-Edge Technologies: We employ a range of leading-edge technologies to manage pain effectively. This includes interventional pain procedures, surgical interventions, neuromodulation (including spinal cord stimulation), and MR-guided focused ultrasound (MRgFUS). Our commitment to innovation ensures that you have access to the latest advancements in pain management.
Clinical Outcomes and Scientific Findings
A comprehensive study, which included 63 MRgFUS procedures with a mean follow-up duration of 55 months, of central lateral thalamotomy (CLT) against chronic neuropathic pain revealed the following:
- Mean pain relief was 42% at 3 months, 43% at 1yr, and 42% at last follow-up.
- Over 50% of patients reported ≥ 50% pain relief at the last follow-up.
- For patients with classical and idiopathic trigeminal neuralgia, the mean pain relief was 76% at the last follow-up, with all patients experiencing ≥ 50% pain relief.
- Interventions for secondary trigeminal neuralgia resulted in a mean pain relief of 31% at the last follow-up.
- Patients with spinal cord injury experienced a mean pain relief of 35% at the last follow-up.
- For postdiscectomy radiculopathy, the mean pain relief was 68% at the last follow-up.
Safety Profile:
No bleeding or infection occurred in any of the 63 interventions.
One patient (1.6% of interventions) experienced numbness on the upper lip during a repeat MRgFUS CLT but with no further adverse effects.
Conclusions:
The overall side-effect profile of MRgFUS CLT speaks for a relatively low-risk neurosurgical approach. Although the average pain relief was modest (42%), its stability over time is remarkable. More than 50% of patients reported ≥ 50% pain relief at a mean follow-up duration of 55 months. Patients with classical and idiopathic trigeminal neuralgia reported even higher average pain relief (76%), as did patients with radiculopathy following previous spinal surgery (68%).
Reference:
Gallay, M. N., Magara, A. E., Moser, D., Kowalski, M., Kaeser, M., & Jeanmonod, D. (2023). Magnetic resonance-guided focused ultrasound central lateral thalamotomy against chronic and therapy-resistant neuropathic pain: retrospective long-term follow-up analysis of 63 interventions. Journal of Neurosurgery, 139(3), 615-624. doi: 10.3171/2023.1.JNS222879
Please consult with your healthcare provider for personalised advice and treatment options related to chronic neuropathic pain.