Treatment of chronic pain with neurostimulation

Chronic pain conditions are a complex and multifactorial problem generally requiring a multidisciplinary-type approach. The central nervous system at some point clearly becomes involved in the processing of these painful conditions with an integration of complex changes in neurophysiology and behavior. Many ablative techniques have been employed in the past to interrupt these signals. However, the results were often temporary and symptoms tended to recur. The more modern approach has suggested that modulation of the nervous elements may be a more resilient approach for treating such chronic pain disorders. We are realizing that many of these pain conditions are also dynamic and evolving, and as such need a similar treatment modality. Neurostimulation, thus, provides the ability of therapeutically dosing electrical current in a variety of pulse forms, amplitudes, pulse widths, and frequencies, to affect that system. Furthermore, it is not destructive, it is reversible, and it can be remotely adjusted and programmed over time; clear advantages to previous surgical therapies. This chapter reports on the current evidence for the use of neurostimulation (i.e. spinal cord stimulation, motor cortex stimulation and deep brain stimulation) in the treatment of chronic pain conditions.