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$Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain$

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Non-invasive brain stimulation techniques for chronic pain.

Neil E O'Connell¹, Benedict M Wand, Louise Marston

¹Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, Kingston Lane, Uxbridge, Middlesex, UK, UB8 3PH.

The Cochrane Database of Systematic Reviews

|April 15, 2014

Summary

Non-invasive brain stimulation techniques like repetitive transcranial magnetic stimulation (rTMS) show limited short-term effects for chronic pain. Evidence suggests low-frequency rTMS, cranial electrotherapy stimulation (CES), and transcranial direct current stimulation (tDCS) are not effective.

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Electrode Positioning and Montage in Transcranial Direct Current Stimulation

Electrode Positioning and Montage in Transcranial Direct Current Stimulation

Published on: May 23, 2011

Area of Science:

Neuroscience
Pain Management
Neuromodulation

Background:

Non-invasive brain stimulation (NIBS) techniques aim to reduce chronic pain by altering brain activity.
Techniques include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), transcranial direct current stimulation (tDCS), and reduced impedance non-invasive cortical electrostimulation (RINCE).

Purpose of the Study:

To evaluate the efficacy of various non-invasive brain stimulation techniques in managing chronic pain.

Main Methods:

Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
Searched multiple databases (CENTRAL, MEDLINE, EMBASE, etc.) from inception to July 2013.
Included studies with sham stimulation, adult patients with pain duration ≥3 months, and pain as a primary outcome; data analyzed using GRADE system.

Main Results:

High-frequency rTMS of the motor cortex showed a small, short-term pain reduction (12%) in single-dose studies, but did not meet minimal clinically important difference criteria.
Low-frequency rTMS and rTMS to the dorsolateral prefrontal cortex were found ineffective (low to very low-quality evidence).
Cranial electrotherapy stimulation (CES) and transcranial direct current stimulation (tDCS) showed no statistically significant difference compared to sham stimulation (low to very low-quality evidence).

Conclusions:

Single doses of high-frequency rTMS may offer minor short-term pain relief, but effects are likely exaggerated by bias and do not meet clinical significance thresholds.
Low-frequency rTMS, CES, and tDCS are generally not effective for chronic pain treatment based on current evidence.
Further large, rigorously designed studies are needed, especially investigating longer stimulation courses, as future evidence may significantly alter these findings.