Case Report: Multidimensional Analgesia via Asymmetric Dual-Target Deep Brain Stimulation of the Periaqueductal Gray and Ventral Posterior Thalamus in Central Post-stroke Pain.

Central post-stroke pain (CPSP) is an intractable neuropathic pain syndrome. Dual-target deep brain stimulation (DBS), which integrates sensory thalamic modulation and endogenous analgesic pathways, has emerged as a potential intervention; however, clinical evidence remains scarce. We report a 54-year-old woman who developed right-sided limb paresthesia progressing to persistent right hemibody pain following a left thalamic hemorrhage. Asymmetric DBS electrodes were implanted in the right periaqueductal gray (R-PAG) and left ventral posterior thalamus (L-VP). Longitudinal assessments utilized standardized scales-including the Visual Analog Scale (VAS), Douleur Neuropathique 4 (DN4) and Hamilton Depression Scale (HAMD). These evaluations demonstrated sustained improvements in pain intensity (VAS: 7 → 1), neuropathic symptoms (DN4: 4 → 1) and depressive symptoms (HAMD: 22 → 8) at the 12-month follow-up. Pain and transient numbness were mitigated by applying cyclic stimulation (5-min on/off intervals). This case highlights the potential of asymmetric dual-target DBS targeting both the PAG and VP to achieve multidimensional analgesia in CPSP and provides insights for optimizing patient selection and treatment strategies, including choices of targets, stimulation parameters and modalities. These findings enhance understanding of neural pathways in chronic pain modulation, specifically the interplay between sensory and emotional processing, and suggest a potential role for asymmetric DBS in treating neuropathic pain.