Neuropathic Pain

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Focused Ultrasound Therapy

Focused ultrasound is an early-stage, non-invasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with neuropathic pain. This novel technology focuses beams of ultrasonic energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue. Where the beams converge, the ultrasound produces precise ablation (thermal destruction of tissue) enabling neuropathic pain to be treated without surgery. While there are several potential treatment targets, the central lateral thalamus has been the target of initial studies.

The primary options for treatment of neuropathic pain include medication and invasive surgery (e.g. deep brain stimulation, radiofrequency lesioning).

For certain patients, focused ultrasound could provide a non-invasive alternative to surgery with less risk of complications and lower cost.

Advantages:

  • Focused ultrasound is non-invasive – no incisions, holes in the skull, electrodes in the brain – and therefore has reduced risk for infection and blood clots.
  • Precise targeting minimizes damage to non-targeted healthy brain.
  • Compared to deep brain stimulation, focused ultrasound is a single procedure, and does not require subsequent procedures/visits to replace batteries, repair broken wires, or adjust simulator settings. It also does not involve the collateral damage to healthy tissue or the risk of infections associated with implanting a foreign body.

Clinical Trials

For a full list of neuropathic pain clinical trials, please see here.

University of Maryland. This study targets the central lateral thalamus for treatment of patients with neuropathic pain. If you would like to learn more about the study, please click here. To inquire about being a part of this study, please contact the following:

  • Ranyah Almardawi, MBBS,MPH – (410) 328-5562
  • Dheeraj Gandhi, MBBS, MD – (248) 497-8856

Israel. Focused ultrasound is used to ablate painful neuromas (visualized on MRI) that are causing amputee stump pain, and the impact on the patient’s level of pain is assessed. To find out more about the study, please click here. To inquire about being a part of this study, please contact the following:

  • Elon Eisenberg, MD – 972-4-7771931

See here for a list of clinical trials

Treatment Sites

See here for a list of treatment sites
See here for a list of clinical trials site
See here for a list of laboratory research sites

Regulatory Approval and Reimbursement

CE approval in Europe was awarded at the end of 2012 to the ExAblate Neuro device for the treatment of neuropathic pain.

At this stage, there is no reimbursement for the use of focused ultrasound to treat neuropathic pain.

Notable Papers

Ghanouni P1, Pauly KB2, Elias WJ3, Henderson J4, Sheehan J3, Monteith S5, Wintermark M6. Transcranial MRI-Guided Focused Ultrasound: A Review of the Technologic and Neurologic Applications. AJR Am J Roentgenol. 2015 Jul;205(1):150-9. doi: 10.2214/AJR.14.13632.

Varma P, Stineman MG, Dillingham TR. Epidemiology of limb loss. Phys Med Rehabil Clin N Am. 2014 Feb;25(1):1-8

Bauer R, Martin E, Haegele-Link S, Kaegi G, von Specht M, Werner B. Noninvasive functional neurosurgery using transcranial MR imaging-guided focused ultrasound. Parkinsonism Relat Disord. 2014 Jan;20 Suppl 1:S197-9.

Hsu E, Cohen SP. Postamputation pain: epidemiology, mechanisms, and treatment. J Pain Res. 2013;6:121-36.

Jeanmonod D, Werner B, Morel A, Michels L, Zadicario E, Schiff G, Martin E. Transcranial magnetic resonance imaging-guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain. Neurosurg Focus. 2012 Jan;32(1):E1.

Martin E, Jeanmonod D, Morel A, Zadicario E, Werner B. High-intensity focused ultrasound for noninvasive functional neurosurgery. Ann Neurol. 2009 Dec;66(6):858-61.

Click here for additional references from PubMed.

Video courtesy of InSightec

     

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