Neuromodulation for chronic pain

Summary Neuromodulation is an expanding area of pain medicine that incorporates array non-invasive, minimally invasive, and surgical electrical therapies. In this Series paper, we focus on spinal cord stimulation (SCS) therapies discussed within the framework other non-invasive neuromodulation These include deep brain motor cortex stimulation, peripheral nerve treatments repetitive transcranial magnetic direct current transcutaneous stimulation. SCS methods with variables differ from traditional have been approved. Although devoid paraesthesias (eg, high frequency) should theoretically allow for placebo-controlled trials, few done. There low-to-moderate quality evidence superior to reoperation or conventional medical management failed back surgery syndrome, conflicting as superiority over sham between different modalities. Peripheral technologies also undergone rapid development become less including many are placed percutaneously. effective neuropathic in extremity, low it without leg pain, can prevent migraines. USA areas Europe, not approved chronic but used off-label refractory cases. Overall, there mixed supporting most sham-controlled trials yielding negative findings. Regarding modalities, moderate does provide meaningful benefit general, regarding relief headaches. For low-quality its a small treatment effect no non-neuropathic pain. Future research better evaluating short-term long-term effectiveness all modalities whether they decrease health-care use, refining selection criteria variables.