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Chronic pain is more than a constant ache; it’s an unrelenting burden that weights on every aspect of life. For millions suffering chronic intractable pain, finding effective treatments can feel like an endless battle. A recent article by Linda Kollenburg, Erkan Kurt and colleagues is shining a light on an unexpected ally in this fight: the cingulum, a central structure within the brain.
For many years the cingulum is known for its profound role in regulating emotions and has therefore long been targeted in treatments for psychiatric disorders like depression. The article, published in Brain Communications in October 16th, highlights the striking similarities between psychiatric conditions and chronic pain, with both involving complex interactions between physical and emotional experiences.
Authors of the article report that the cingulum can be considered a ‘central hub’ connecting many brain areas involved in regulating emotion and pain, and therefore further explored the efficacy of different techniques targeting the cingulum in patients with chronic intractable pain. Treatments targeting the cingulum use different strategies to interfere with the activity of the nerve fibres located within.
In cingulotomy, a heated tip is used to create lesions in the cingulum, leading to selective inhibition of the fibres going through. Another strategy inhibiting the cingulate activity involves the release of electrical pulses to the cingulum by implanting an electrode directly on its fibre bundle, referred to as deep brain stimulation (DBS-ACC).
The article thoroughly reviews evidence for these treatment modalities and shows that both cingulotomy and DBS-ACC are effective treatment options for chronic pain in the last resort with many patients reporting that they ‘are no longer bothered’ by their pain. Whereas cingulotomy has permanent effects with low costs and delivers rapid pain relief, DBS-ACC has reversible effects however is more costly and takes longer to achieve optimal effects. Choosing between these treatments requires a careful evaluation of the patients’ individual need and condition, thus emphasizing the importance of patient centred care.
Future directions
This publication is part of the ‘Cingulate Project’ at Radboudumc, which encompasses various research initiatives aimed at further exploring the involvement of the cingulum in chronic pain alongside its potential as a neurosurgical target. Looking ahead, the authors are planning on further mapping the anatomical and connectivity properties of the cingulum, allowing for an improved understanding of its involvement in pain processing, refining techniques and addressing key surgical challenges in targeting of the cingulum. Prospective clinical trials which further evaluate the efficacy of neurosurgical techniques targeting the cingulum in patients with chronic intractable pain are warranted.
This research is part of the Radboudumc Research program: Quality of life of vulnerable patients.
About the publication
The article has been initiated by Radboudumc and is written in collaboration with an international team.
Kollenburg L, Arnts H, Green A, Strauss I, Vissers K, Vinke S, Kurt E. The cingulum: A central hotspot for the battle against chronic intractable pain. Brain communications. 2024 Oct;6(5) https://academic.oup.com/braincomms/article/6/5/fcae368/7823732
