Neuromodulation for central pain

Abstract

Central pain, which follows brain and spinal cord injury remains an ill-treated entity affecting approximately 1-2 million people worldwide. When oral drugs fail, either immediately or in the long run, the only therapeutic option is neuromodulation, via either electrical or chemical means. The whole spectrum of neuromodulatory techniques for central pain is poorly appreciated by pain therapists. Results of all these techniques provide rational guidelines for the treating physician and are detailed in this review. Reviewed techniques include cortical, deep brain and spinal cord stimulation, transcutaneous electrical nerve stimulation, electroconvulsion, and pump infusion of intrathecal drugs.

Spinal Cord Stimulation for Pain Treatment After Spinal Cord Injury

“…In addition, such procedures benefit only a small group of patients. Some patients report recurring pain even after these procedures [70,71]. Since the discovery by Luigi Galvani in the 18th century that electricity can modulate nerve activity, various modes of functional neurostimulation therapies have been developed for improving the primary and secondary outcomes of SCI, such as regaining motor function, alleviating spasticity, triggering cough, assisting breathing, and improving bowel and bladder control [72].…”

Surgical Neurostimulation for Spinal Cord Injury

“…Current indications of neurostimulation for pain include pain from failed back surgery syndrome (FBSS), neuropathic pain secondary to peripheral nerve injury (e.g., amputation, brachial plexus injury), facial pain and headache disorders [ 63 , 64 ]. Interventions can target any part of an impaired nociceptive pathway, including at the level of the spinal cord, deep brain nuclei or motor cortex [ 65 , 66 ].…”

Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

“…7 However, the results for SCS for pain management have been disappointing compared with those for other indications such as peripheral neuropathy, failed back surgery syndrome, complex regional pain syndrome and multiple sclerosis. 8–12…”

“…7 However, the results for SCS for pain management have been disappointing compared with those for other indications such as peripheral neuropathy, failed back surgery syndrome, complex regional pain syndrome and multiple sclerosis. [8][9][10][11][12] Burst waveform SCS was developed as an alternative to conventional tonic waveform SCS. 13 Compared with the constant, unchanging pulses that are delivered during conventional tonic waveform SCS, five pulses are delivered at 500 Hz and the burst repeats at 40 Hz in burst SCS.…”