Conclusion

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Despite the reported success with MCS for the treatment of trigeminal neuropathic pain, there have been no large, controlled, prospective, randomized trials of this modality. We face a situation similar to that experienced with deep brain stimulation (DBS) for pain in the 1970s and 1980s. The procedure was widely utilized with little strong evidence for efficacy until two prospective trials were eventually performed in the 1990s. These trials showed that DBS for pain could be effective, but suggested a very low percentage (13.5 to 17.8%) of patients could be proven to have clinically significant pain relief at long-term follow-up (Coffey, 2001). The lesson learned from this study was that future trials of analgesic devices follow structured protocols for patient selection and utilize uniform implantation and treatment paradigms. It is imperative that MCS be subjected to this type of scrutiny prior to its widespread adoption as a potential standard therapy for chronic pain.

MCS is a promising therapy for use in the treatment of complex central and neuropathic pain syndromes refractory to medical treatment. Ongoing basic and clinical evaluation will provide additional information into the mechanisms, surgical technique, indications, and long-term treatment effectiveness of MCS for patients who suffer from a variety of challenging pain syndromes.

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