Non-invasive stimulation therapies for the treatment of refractory pain Full Text
Discovery Medicine, 08/01/2012
Nizard J et al. – This also includes the availability of new coils and magnetic field waveforms and progress in neuronavigation techniques, especially by the integration of functional imaging and high–resolution EEG data.Methods
- Drug-refractory pain is an indication for neurostimulation therapy, which can be either non-invasive [mainly transcutaneous electrical nerve stimulation (TENS), repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial direct current stimulation (tDCS)] or invasive which requires the intervention of a surgeon to implant electrodes and a pulse generator [peripheral nerve stimulation (PNS), nerve root stimulation (NRS), spinal cord stimulation (SCS), deep brain stimulation (DBS), and motor cortex stimulation (MCS)].
- In this review, the respective mechanisms of action and efficacy of TENS, rTMS, and tDCS are discussed.
- The advantages of TENS include non-invasiveness and ease to use, so that the technique can be operated by the patient.
- TENS can be indicated as a first-line treatment in patients suffering from peripheral neuropathic pain if the painful area is limited and the sensory deficit moderate.
- The current best indications are chronic radiculopathies, mononeuropathies, and postherpetic pain.
- Test sessions allow to select suitable patients and to determine the site, frequency, and optimal intensity of stimulation.
- Three to four 30- to 60-minute sessions per day are usually recommended.
- With regard to rTMS, published randomized controlled studies in chronic neuropathic and non-neuropathic pain (fibromyalgia) reached a sufficient level of evidence to recommend this technique for the indication of implanted motor cortex stimulation for the treatment of refractory neuropathic pain or as a long-term treatment for pain syndromes, in which surgery is not indicated, such as fibromyalgia.
- Other indications, concerning either chronic or acute pain syndromes, such as postoperative pain, should be developed in parallel with the optimization of stimulation parameters.