Stimulation methods for neuropathic pain control

Abstract

Neurostimulation methods for control of chronic neuropathic pain have recently gained in popularity. The reasons for this are multifactorial. As opposed to nerve ablation, these methods are minimally invasive and reversible. The improvements in hardware design simplified implantation techniques and prolonged equipment longevity. Stimulation trials have become less invasive, allowing patients to test its effects before final implantation. Finally, the scientific evidence has shown good outcomes of neurostimulation methods for chronic neuropathic pain control. Recent research efforts have revealed new potential mechanisms of action of neurostimulation. Whereas its action was widely explained by gate control theory in the past, it seems that neuromodulation acts also by modulation of neurotransmitters in the central nervous system. Three neurostimulation methods are currently used in clinical practice: spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), and deep brain stimulation (DBS). The SCS and PNS are excellent treatment choices for certain forms of neuropathic pain. The new indications for SCS are end-stage peripheral vascular disease and ischemic heart disease, whereas PNS is used for the treatment of occipital neuralgia and chronic pelvic pain. DBS is reserved for carefully selected patients in whom the other treatment modalities have failed. In a minority of patients the "tolerance" to neurostimulation develops after long-term use. Further research is needed to establish better outcome predictors to neurostimulation and possibly improve patient selection criteria.

Subcutaneous targeted neuromodulation technique for the treatment of intractable chronic postthoracotomy pain

“…In several studies, the success rate of the technique has been raised to 90% to 100% in neuropathic pain and 40% to 60% in low back pain [20][21][22][23]. The combination of spinal cord stimulation with targeted subcutaneous stimulation or peripheral nerve stimulation may further improve the above result 8 .…”

Neuromodulation and Non-Pharmacological Treatment of Migraine

“…55,56 In conclusion, neuromodulation studies show some efficacy in the acute and preventive treatment of migraine. The results of vagal nerve stimulation are promising and sphenopalatine ganglion stimulation studies might be very interesting and may shed light into our understanding of pathomechanism of headache.…”

Chronisches Schmerzsyndrom des Beckens

“…Bei der tiefen Hirnstimulation ("deep brain stimulation", DBS), die bereits seit den 70er Jahren [20] des letzten Jahrhunderts eingesetzt wird, werden eine oder mehrere Elektroden in eine bestimmte Hirnregion implantiert, so dass dauerhaft elektrische Impulse abgegeben werden können, die je nach dem stimulierend oder deaktivierend wirken. Diese Methode wird v. a. bei der Behandlung verschiedener therapierefraktärer Bewegungsstörungen wie bei Morbus Parkinson, essentiellem Tremor und Dystonie eingesetzt.…”