• Rubens G Cury, Ricardo Galhardoni, Erich T Fonoff, Maria G Dos Santos Ghilardi, Fernanda Fonoff, Debora Arnaut, Martin L Myczkowski, Marco A Marcolin, Edson Bor-Seng-Shu, Egberto R Barbosa, Manoel J Teixeira, and Daniel Ciampi de Andrade.
• From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
• Neurology. 2014 Oct 14;83(16):1403-9.

ObjectiveTo prospectively evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the different characteristics of pain and other nonmotor symptoms (NMS) in patients with Parkinson disease (PD).MethodsForty-four patients with PD and refractory motor symptoms were screened for STN-DBS. Patients were evaluated before and 1 year after surgery. The primary outcome was change in pain prevalence after surgery. Secondary outcome measures were changes in motor function (Unified Parkinson's Disease Rating Scale), characteristics of pain and other NMS using specific scales and questionnaires, and quality of life.ResultsForty-one patients completed the study. The prevalence of pain changed from 70% to 21% after surgery (p < 0.001). There were also significant improvements in pain intensity, NMS, and quality of life after STN-DBS (p < 0.05). Dystonic and musculoskeletal pain responded well to DBS, while central pain and neuropathic pain were not influenced by surgery. There was a strong correlation between the change in pain intensity and the improvement in quality of life (r = 0.708, p < 0.005). No correlation was found between pain improvement and preoperative response to levodopa or motor improvement during stimulation (r = 0.247, p = 0.197 and r = 0.249, p = 0.193, respectively) or with changes in other NMS.ConclusionsSTN-DBS decreased pain after surgery, but had different effects in different types of PD-related pain. Motor and nonmotor symptom improvements after STN-DBS did not correlate with pain relief.Classification Of EvidenceThis study provides Class IV evidence that in patients with idiopathic PD with refractory motor fluctuations, STN-DBS decreases the prevalence of pain and improves quality of life.© 2014 American Academy of Neurology.

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