From Mechanisms to Analgesia: Towards the Use of Non-Invasive Neuromodulation for Pain Relief in the Clinic (original) (raw)
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Spinal Cord Stimulation: The Use of Neuromodulation for Treatment of Chronic Pain
2020
INTRODUCTION Chronic Pain and the Role of Neuromodulation Chronic pain, defined as pain persistent for more than 3–6 months, affects 100 million adults in the United States (US) and impacts all dimensions of health-related quality of life (QOL) and healthcare expenditures.1 Low back pain is the leading cause of disability, with healthcare expenditures estimated to be as much as 560–560–560–635 billion, more than the combined spending on heart disease and diabetes.1 Despite lack of consistent evidence, rates of spine surgeries have increased, while other forms of chronic pain management, including narcotics, contribute to both adverse medical side effects and the ongoing opioid epidemic.2 As such, additional treatment options for chronic pain are being studied. One promising option is spinal cord stimulation (SCS), a form of neuromodulation used since the 1960s. Recently, a paradigm shift has occurred, with SCS increasingly accepted as a first-line therapy after noninvasive treatment (phys...
Results of neuromodulation for the management of chronic pain
Neurologia i Neurochirurgia Polska, 2011
Background and purpose: Neuromodulative treatment of chronic pain syndromes is a modern mode of treatment of neuropathic and ischaemic pain. Its effectiveness is well documented in the literature. The objective of this work is to present the results of treatment of chronic pain syndromes on the basis of eight-year experience in our department. Material and methods: Since 2002, we have conducted 9 operations of motor cortex stimulation (MCS), 2 of deep brain stimulation (DBS), 45 of spinal cord stimulation (SCS) and 5 of sacral root stimulation (SRS) in the treatment of chronic pain. Results: We obtained good long-term results of neuromodula tion in the form of clinical improvement (> 50%) in 4 of 9 pa tients with MCS (44%), in 13 diagnosed with failed back surgery syndrome (FBSS), 8 with other neuropathic pain, and 11 with angina pectoris from a group of 45 treated with SCS. Sacral root stimulation has been successful in 3 of 5 patients with perianal pain. The best treatment results in SCS, although not statistically significant, were observed in patients treated due to FBSS (13 out of 15) and angina pectoris (11 out of 15) (p = 0.12). In patients with neuropathic pain, peripheral and central, improvement was obtained in 8 out of 15 patients. Conclusions: A good indication for spinal cord stimulation is FBSS and angina pectoris. Motor cortex stimulation is helpful in the treatment of chronic central neuropathic pain. Further observations and a larger group of patients are necessary for a reliable assessment of the effectiveness of neuromodulative treatment of chronic pain in our clinic.
Emerging targets and uses of neuromodulation for pain
Expert Review of Neurotherapeutics, 2019
Introduction: There has been great development in the testing of invasive and non-invasive neuromodulation for chronic pain. To date, it is known that central and peripheral stimulation targets, combined or not, may influence chronic pain sensation. Although most of the significant results of chronic pain studies come from motor cortex stimulation, novel targets are being explored to increase effect sizes and to induce pain relief in non-responders. Areas covered: In this article, we discuss three emerging targets of non-invasive neuromodulation for chronic pain: (i) a central target: prefrontal cortex stimulation; (ii) a peripheral target: vagal nerve stimulation (VNS); and (iii) a combined peripheral-central target: combination of central and peripheral neural stimulation. Expert commentary: Clinical trials' results on novel targets for chronic pain are at an earlier stage and the mechanisms involved with their combination remain unclear. An important challenge to validate new targets is to determine whether they may be equivalent or even more effective than traditional ones. In spite of the significant advance in this field, especially in refractory chronic pain, mechanistic elements are yet to be comprehended. Thus, exploring multifactorial aspects of novel brain stimulation approaches is fundamental to achieve meaningful results and further augment clinical practice.
Brain Stimulation in the Treatment of Chronic Neuropathic and Non-Cancerous Pain
The Journal of Pain, 2012
Chronic neuropathic pain is one of the most prevalent and debilitating disorders. Conventional medical management, however, remains frustrating for both patients and clinicians owing to poor specificity of pharmacotherapy, delayed-onset of analgesia and extensive side-effects. Neuromodulation presents as a promising alternative, or at least an adjunct, as it is more specific in inducing analgesia without associated risks of pharmacotherapy. Here, we discuss common clinical and investigational methods of neuromodulation. Compared to clinical spinal cord stimulation (SCS), investigational techniques of cerebral neuromodulation, both invasive [deep brain stimulation (DBS) and motor cortical stimulation (MCS)] and noninvasive [repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)], may be more advantageous. By adaptively targeting the multi-dimensional experience of pain, subtended by integrative pain circuitry in the brain, including somatosensory and thalamocortical, limbic and cognitive, cerebral methods may modulate the sensory-discriminative, affectiveemotional and evaluative-cognitive spheres of the pain neuromatrix. Despite promise, the current
Neuromodulation: Technology at the Neural Interface, 2018
Objective: The physiological mechanisms behind the therapeutic effects of spinal cord stimulation (SCS) are only partially understood. Our aim was to perform a literature review of studies that used objective measures to characterize mechanisms of action of SCS in neuropathic pain patients. Materials and Methods: We searched the PubMed data base to identify clinical studies that used objective measures to assess the effects of SCS in neuropathic pain. We extracted the study factors (e.g., type of measure, diagnoses, painful area[s], and SCS parameters) and outcomes from the included studies. Results: We included 67 studies. Of these, 24 studies used neurophysiological measures, 14 studies used functional neuroim-aging techniques, three studies used a combination of neurophysiological and functional neuroimaging techniques, 14 studies used quantitative sensory testing, and 12 studies used proteomic, vascular, and/or pedometric measures. Our findings suggest that SCS largely inhibits somatosensory processing and/or spinal nociceptive activity. Our findings also suggest that SCS modulates activity across specific regions of the central nervous system that play a prominent role in the sensory and emotional functions of pain. Conclusions: SCS appears to modulate pain via spinal and/or supraspinal mechanisms of action (e.g., pain gating, descending pain inhibition). However, to better understand the mechanisms of action of SCS, we believe that it is necessary to carry out systematic, controlled, and well-powered studies using objective patient measures. To optimize the clinical effectiveness of SCS for neuropathic pain, we also believe that it is necessary to develop and implement patient-specific approaches.
A Prospective Six-Month Study of Chronic Pain Sufferers: A Novel OTC Neuromodulation Therapy
Pain Research and Management
Objective. To assess the durability of treatment over various chronic pain conditions of an emerging, nonprescription electromagnetic neuromodulation device that uses pulsed shortwave therapy. Methods. A 6-month prospective study, involving 240 chronic pain sufferers, 94% of whom reported using pain pills and 98% reported using pain therapies prior to entering the study. Their average baseline pain was 8.2 VAS points before treatment; they had a pain duration of 6.5 years, and they were positive responders to pulsed shortwave therapy in an initial 7-day trial. Prospective assessments were obtained at intervals of 3, 4, and 6 months following a retrospective 7-day assessment. Longitudinal analyses were conducted to determine pain relief trends after the initial 7-day device use. Results. Seven days after initial treatment, the average pain was reduced to 2.9, a 65% pain reduction for the study subjects. At the 6-month measurement, the average pain was 3.3, a 60% pain reduction from b...
PAIN Reports, 2019
Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.
Neuromodulation Therapy in Chronic Pain and Clinical Outcomes: A Single-Center Experience
Anestezi dergisi, 2022
Objective: Neuromodulation therapies are successful treatment options for pain raised from a variety of etiologies. Careful patient selection and multidisciplinary evaluation are essential to achieve the best outcome. We aimed to discuss the common indications of neuromodulation therapies, efficacy, and clinical outcomes of patient follow-up to 3 and 6 months. Methods: Twentytree patients completed the 6-month followup: four underwent cervical spinal cord stimulation (SCS), sixteen had thoracic SCS, and three had sacral neuromodulation (SNS). Outcome measures were pain (visual analog scale[VAS]), quality of life (36-Item Short Form Survey [SF-36]), Oswestry Disability Index [ODI]), and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) neuropathic pain scale questionnaire. The overactive bladder assessment form and the pelvic pain impact questionnaire were performed on patients who would undergo SNS. Results: A significant difference was shown in regards to the scores of the VAS, SF-36 parameters, ODI, and LANSS between admission and the third and sixth-month follow-ups (p<0.001). Visual Analog Scale, ODI, and LANSS sixth-month scores were also lower than the third-month scores (p=0.001). There were no significant differences between the groups in terms of sex. Conclusion: Neuromodulation therapies provide short and longterm pain relief and quality-of-life improvements in patients with refractory chronic pain syndromes.
Pain-Relieving Mechanisms in Neuromodulation
Deer's Treatment of Pain, 2019
Neuromodulation is the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body. Here, in addition to historical perspectives, we expansively discuss the pain-relieving mechanisms of neuromodulation, referring frequently to the basic translation and clinical literature and devoting particular attention to spinal cord stimulation.