The role of neurostimulation in the treatment of neuropathic pain.

The treatment of chronic pain syndromes may include pharmacological, physiotherapeutic, and invasive methods. Considerable number of patients do not achieve sufficient pain relief with pharmacotherapy, in these patients with neuropathic pain, electrical neurostimulation may be applied. The available neurostimulation techniques which may be offered to the patients are: transcutaneous electrical nerve stimulation (TENS), peripheral nerve stimulation (PNS), nerve root stimulation (NRS), spinal cord stimulation (SCS), deep brain stimulation (DBS), epidural motor cortex stimulation (MCS), and repetitive transcranial magnetic stimulation (rTMS). These techniques vary in their invasiveness, stimulated structures and rationale, but they are all modifiable and reversible. Neurostimulation therapy is also used in addition to the current medical treatment in different neurological disorders, including Parkinson's disease, dystonia, obsessive-compulsive disorder, refractory pain, epilepsy and migraine. The article provides the physicians the knowledge on different neurostimulation techniques for treatment of chronic neuropathic pain and their effectiveness.