Ventral posterior medial (VPM) stimulation in combination with centromedian (CM) stimulation was found to be a promising target for neuropathic dental pain. 

A study was carried to explore optimal thalamic target to alleviate neuropathic dental pain with the help of the steering abilities of a directional deep brain stimulation electrode.

Review and literature search of the database detected three potential thalamic targets. Implantation of the directional lead was done in a patient having neuropathic dental pain. Its current steering was utilized to determine the effects in each nucleus.

The pain was reported by the patient after two weeks of stimulation in a randomized prospective blinded study. Estimation of quality of life was carried out before and after three months. 

Three potential nuclei were detected: (i) CM, (ii) VPM, and (iii) anterior pulvinar. The best results were witnessed during CM stimulation (50% decline) and VPM stimulation (>90% decline in pain).

After three months of the VPM-deep brain stimulation in combo with lateral CM stimulation, the pain disability was found to decrease from 25 to 0 while the short form 36 improved from 67.5 to 90. Deep brain stimulation electrode directionality can be utilized for testing multiple targets and selecting a patient-specific "sweet spot" to alleviate dental pain.

Directional deep brain stimulation can target the thalamic optimal target and minimize neuropathic dental pain.