# Transcranial Focused Ultrasound for Head and Neck Cancer Pain.  A Pilot Study

> **NIH NIH UH3** · UNIVERSITY OF VIRGINIA · 2020 · $575,521

## Abstract

PROJECT SUMMARY
Head and neck cancer is particularly susceptible to nocioceptive and neuropathic pains
because it is dense with sensitive anatomic structures and richly innervated by the
nervous system. In fact, head and neck cancer, estimated as the ninth most common
cancer and cause of cancer mortality, is associated with the highest prevalence of pain.
These craniocervical pains are particularly difficult for three reasons. Firstly, medical
therapy often wanes in effect and/or high doses are required with cognitive side effects.
Secondly, surgical options are limited by the cephalad extent in the neural axis. Lastly,
cancer and its terminal stages are difficult for invasive surgery or implanted devices that
require intensive management. Patients and their oncologists seek pain relief that is easy,
safe, and without cognitive side effects.
Transcranial MRI-guided focused ultrasound (FUS) is a new stereotactic modality
capable of delivering high intensity energy through the intact human skull with
submillimeter precision. Our initial experience with FUS targeted the ventrolateral
thalamus for essential tremor and Parkinson’s disease, eventually leading to FDA
approvals. Cancer pain is an ideal indication to consider stereotactic ablation as the
disease burden limits the options. A minimally invasive, transcranial option to treat
refractory cancer pain would be welcomed by patients – avoiding opioid medications,
open surgery, and device implantation.
This exploratory clinical trial (already approved by the FDA under IDE#G180222) will
target both the spinothalamic and spinoreticular pain circuits by performing unilateral FUS
mesencephalotomy, a historically effective procedure for cancer pain but limited by the
accuracy of its era. The primary aim of this study is to assess the safety and preliminary
effectiveness in six head and neck cancer patients with opioid-resistant pain.
Additionally, we will investigate the potential mechanism of pain relief as the
mesencephalotomy target involves the confluence of the ascending and descending pain
systems. Aims 2 and 3 will investigate these systems with electrophysiology specific for
the spinothalamic tract and carfentanil PET imaging that measures the brain’s
endogenous opioids.

## Key facts

- **NIH application ID:** 10023961
- **Project number:** 5UH3NS115118-02
- **Recipient organization:** UNIVERSITY OF VIRGINIA
- **Principal Investigator:** William Jeffrey Elias
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $575,521
- **Award type:** 5
- **Project period:** 2019-09-30 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10023961

## Citation

> US National Institutes of Health, RePORTER application 10023961, Transcranial Focused Ultrasound for Head and Neck Cancer Pain.  A Pilot Study (5UH3NS115118-02). Retrieved via AI Analytics 2026-06-08 from https://api.ai-analytics.org/grant/nih/10023961. Licensed CC0.

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