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Related Concept Videos

Analgesia and Pain Management01:25

Analgesia and Pain Management

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Nociception—the ability to feel pain—is essential for an organism’s survival and overall well-being. Noxious stimuli such as piercing pain from a sharp object, heat from an open flame, or contact with corrosive chemicals are first detected by sensory receptors, called nociceptors, located on nerve endings. Nociceptors express ion channels that convert noxious stimuli into electrical signals. When these signals reach the brain via sensory neurons, they are perceived as pain.
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Neuromodulation for chronic pain.

Helena Knotkova1, Clement Hamani2, Eellan Sivanesan3

  • 1MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.

Lancet (London, England)
|June 1, 2021
PubMed
Summary
This summary is machine-generated.

Neuromodulation therapies, including spinal cord stimulation (SCS), offer electrical treatments for pain. Evidence for their effectiveness varies, with ongoing research needed to refine patient selection and treatment variables for optimal outcomes.

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Area of Science:

  • Pain Medicine
  • Neurology
  • Neurosurgery

Background:

  • Neuromodulation encompasses diverse electrical therapies for pain management, ranging from non-invasive to surgical interventions.
  • Spinal cord stimulation (SCS) is a key focus, alongside other invasive and non-invasive techniques like deep brain stimulation and repetitive transcranial magnetic stimulation.

Purpose of the Study:

  • To review and synthesize the current evidence for various neuromodulation therapies in pain management.
  • To evaluate the efficacy and limitations of different neuromodulation modalities, including spinal cord stimulation, peripheral nerve stimulation, brain stimulation, and non-invasive techniques.

Main Methods:

  • Systematic review of existing literature on neuromodulation therapies for chronic pain conditions.
  • Analysis of evidence quality regarding the superiority of different neuromodulation techniques over sham stimulation, placebo, or conventional treatments.

Main Results:

  • Low-to-moderate evidence supports SCS for failed back surgery syndrome, but evidence for superiority over sham or other SCS modalities is conflicting.
  • Peripheral nerve stimulation shows low-to-moderate evidence for neuropathic extremity pain, with conflicting evidence for migraines and back pain.
  • Non-invasive modalities like repetitive transcranial magnetic stimulation and transcranial direct current stimulation have mixed or low-quality evidence for chronic pain, neuropathic pain, and headaches.

Conclusions:

  • The effectiveness of various neuromodulation therapies for chronic pain is supported by mixed or low-quality evidence.
  • Further research is crucial to evaluate long-term effectiveness, impact on healthcare utilization, and to refine patient selection and treatment parameters for neuromodulation.