scholarly journals Neurostimulation Methods in the Treatment of Chronic Pain

2012 ◽  
pp. S23-S31 ◽  
Author(s):  
R. ROKYTA ◽  
J. FRICOVÁ
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Cortex Stimulation ◽  
Positive Effects ◽  
Non Invasive ◽  
Different Types ◽  
Deep Brain

The main neuromodulatory methods using neurostimulation principles are described. It concerns peripheral nerve stimulation (PNS), spinal cord stimulation (SCS), deep brain stimulation (DBS), motor cortex stimulation (MSC), and repetitive transcranial magnetic stimulation (rTMS). For each method the history, pathophysiology, the principles for use and the associated diagnoses are mentioned. Special attention is focused on the most common neuromodulatory invasive methods like SCS and MCS and non-invasive methods such as rTMS. In addition to the positive effects, side effects and complications are described and discussed in detail. In conclusion, neuromodulatory (neurostimulatory) techniques are highly recommended for the treatment of different types of pharmacoresistant pain.

Deep Brain Stimulation and Motor Cortex Stimulation for Chronic Pain

2020 ◽  
Vol 68 (8) ◽  
pp. 235
Author(s):  
Patrick Senatus ◽  
Sarah Zurek ◽  
Milind Deogaonkar
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Motor Cortex ◽  
Brain Stimulation ◽  
Motor Cortex Stimulation ◽  
Deep Brain

Neuromodulatory approaches for bipolar disorder: current evidences and future perspectives

2017 ◽  
Author(s):  
Andre Russowsky Brunoni ◽  
Bernardo de Sampaio Pereira Júnior ◽  
Izio Klein
Keyword(s):  
Bipolar Disorder ◽  
Deep Brain Stimulation ◽  
Vagus Nerve Stimulation ◽  
Magnetic Stimulation ◽  
Treatment Strategies ◽  
Future Perspectives ◽  
Non Invasive ◽  
Invasive Techniques ◽  
High Degree ◽  
Deep Brain

Bipolar disorder is a prevalent condition, with few therapeutic options and a high degree of refractoriness. This justifies the development of novel non-pharmacological treatment strategies, such as the non-invasive techniques of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), as well as the invasive techniques of deep brain stimulation (DBS) and vagus nerve stimulation (VNS). In this chapter, we provide a summary of the development of the techniques as well as the studies carried out with patients with bipolar disorder. Although many promising results regarding the efficacy of theses techniques were described, the total number of studies is still low, highlighting the need of further studies in larger samples as to provide a definite picture regarding the use of clinical neuromodulation in bipolar disorder.

scholarly journals Intracranial Neurostimulation for Pain Control: A Review

2010 ◽  
Vol 2;13 (1;2) ◽  
pp. 157-165
Author(s):  
Timothy R. Deer
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Deep Brain Stimulation ◽  
Motor Cortex ◽  
Brain Stimulation ◽  
Randomized Clinical Trials ◽  
Surgical Techniques ◽  
Motor Cortex Stimulation ◽  
Failed Back Surgery ◽  
Deep Brain

Intracranial neurostimulation for pain relief is most frequently delivered by stimulating the motor cortex, the sensory thalamus, or the periaqueductal and periventricular gray matter. The stimulation of these sites through MCS (motor cortex stimulation) and DBS (deep brain stimulation) has proven effective for treating a number of neuropathic and nociceptive pain states that are not responsive or amenable to other therapies or types of neurostimulation. Prospective randomized clinical trials to confirm the efficacy of these intracranial therapies have not been published. Intracranial neurostimulation is somewhat different than other forms of neurostimulation in that its current primary application is for the treatment of medically intractable movement disorders. However, the increasing use of intracranial neurostimulation for the treatment of chronic pain, especially for pain not responsive to other neuromodulation techniques, reflects the efficacy and relative safety of these intracranial procedures. First employed in 1954, intracranial neurostimulation represents one of the earliest uses of neurostimulation to treat chronic pain that is refractory to medical therapy. Currently, 2 kinds of intracranial neurostimulation are commonly used to control pain: motor cortex stimulation and deep brain stimulation. MCS has shown particular promise in the treatment of trigeminal neuropathic pain and central pain syndromes such as thalamic pain syndrome. DBS may be employed for a number of nociceptive and neuropathic pain states, including cluster headaches, chronic low back pain, failed back surgery syndrome, peripheral neuropathic pain, facial deafferentation pain, and pain that is secondary to brachial plexus avulsion. The unique lack of stimulation-induced perceptual experience with MCS makes MCS uniquely suited for blinded studies of its effectiveness. This article will review the scientific rationale, indications, surgical techniques, and outcomes of intracranial neuromodulation procedures for the treatment of chronic pain. Key words: Motor cortex stimulation, deep brain stimulation, pain, neurostimulation

scholarly journals The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation

2018 ◽  
Vol 8 (8) ◽  
pp. 158 ◽  
Author(s):  
Sarah Farrell ◽  
Alexander Green ◽  
Tipu Aziz
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Study Data ◽  
Anterior Cingulate ◽  
Intractable Pain ◽  
Motor Cortex Stimulation ◽  
Current State ◽  
Professional Opinion ◽  
Deep Brain

Chronic intractable pain is debilitating for those touched, affecting 5% of the population. Deep brain stimulation (DBS) has fallen out of favour as the centrally implantable neurostimulation of choice for chronic pain since the 1970–1980s, with some neurosurgeons favouring motor cortex stimulation as the ‘last chance saloon’. This article reviews the available data and professional opinion of the current state of DBS as a treatment for chronic pain, placing it in the context of other neuromodulation therapies. We suggest DBS, with its newer target, namely anterior cingulate cortex (ACC), should not be blacklisted on the basis of a lack of good quality study data, which often fails to capture the merits of the treatment.

scholarly journals Magnetically Induced Temporal Interference for Focal and Deep-Brain Stimulation

2021 ◽  
Vol 15 ◽  
Author(s):  
Zonghao Xin ◽  
Akihiro Kuwahata ◽  
Shuang Liu ◽  
Masaki Sekino
Keyword(s):  
Deep Brain Stimulation ◽  
Electric Field ◽  
Brain Stimulation ◽  
Magnetic Stimulation ◽  
Brain Regions ◽  
Potential Candidate ◽  
Non Invasive ◽  
Neural Modulation ◽  
Stimulation Method ◽  
Deep Brain

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that has been clinically applied for neural modulation. Conventional TMS systems are restricted by the trade-off between depth penetration and the focality of the induced electric field. In this study, we integrated the concept of temporal interference (TI) stimulation, which has been demonstrated as a non-invasive deep-brain stimulation method, with magnetic stimulation in a four-coil configuration. The attenuation depth and spread of the electric field were obtained by performing numerical simulation. Consequently, the proposed temporally interfered magnetic stimulation scheme was demonstrated to be capable of stimulating deeper regions of the brain model while maintaining a relatively narrow spread of the electric field, in comparison to conventional TMS systems. These results demonstrate that TI magnetic stimulation could be a potential candidate to recruit brain regions underneath the cortex. Additionally, by controlling the geometry of the coil array, an analogous relationship between the field depth and focality was observed, in the case of the newly proposed method. The major limitations of the methods, however, would be the considerable intensity and frequency of the input current, followed by the frustration in the thermal management of the hardware.

scholarly journals Deep brain stimulation for the treatment of various chronic pain syndromes

2006 ◽  
Vol 21 (6) ◽  
pp. 1-8 ◽  
Author(s):  
Dirk Rasche ◽  
Patricia C. Rinaldi ◽  
Ronald F. Young ◽  
Volker M. Tronnier
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Long Term Results ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes ◽  
Deep Brain

Object Electrical intracerebral stimulation (also referred to as deep brain stimulation [DBS]) is a tool for the treatment of chronic pain states that do not respond to less invasive or conservative treatment options. Careful patient selection, accurate target localization, and identification with intraoperative neurophysiological techniques and blinded test evaluation are the key requirements for success and good long-term results. The authors present their experience with DBS for the treatment of various chronic pain syndromes. Methods In this study 56 patients with different forms of neuropathic and mixed nociceptive/neuropathic pain syndromes were treated with DBS according to a rigorous protocol. The postoperative follow-up duration ranged from 1 to 8 years, with a mean of 3.5 years. Electrodes were implanted in the somatosensory thalamus and the periventricular gray region. Before implantation of the stimulation device, a double-blinded evaluation was carefully performed to test the effect of each electrode on its own as well as combined stimulation with different parameter settings. The best long-term results were attained in patients with chronic low-back and leg pain, for example, in so-called failed–back surgery syndrome. Patients with neuropathic pain of peripheral origin (such as complex regional pain syndrome Type II) also responded well to DBS. Disappointing results were documented in patients with central pain syndromes, such as pain due to spinal cord injury and poststroke pain. Possible reasons for the therapeutic failures are discussed; these include central reorganization and neuroplastic changes of the pain-transmitting pathways and pain modulation centers after brain and spinal cord lesions. Conclusions The authors found that, in carefully selected patients with chronic pain syndromes, DBS can be helpful and can add to the quality of life.

scholarly journals Repetitive transcranial magnetic stimulation in the treatment of chronic low back pain. A systematic review (Part I)

2021 ◽  
pp. 80-90
Author(s):  
Ю.А. Меркулов ◽  
А.Е. Гореликов ◽  
А.А. Пятков ◽  
Д.М. Меркулова
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Transcranial Magnetic Stimulation ◽  
Chronic Low Back Pain ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
High Tech ◽  
Low Back ◽  
Positive Effects

Цель обзора - анализ результатов исследований эффективности ритмической транскраниальной и трансспинальной магнитной стимуляции (рТМС и рТсМС) в лечении боли в пояснице. Хроническая боль в нижней части спины (ХБНЧС) составляет 22% от всех случаев хронической боли и 35% от рефрактерных болевых синдромов, и осложняется изменчивостью проявлений и механизмов, лежащих в ее основе. Невысокие успехи традиционного лечения и реабилитации пациентов с ХБНЧС не учитывают каскад нейрофизиологических изменений (нейропластичность), включающий в себя сложное взаимодействие между повреждением тканей, изменением афферентной информации, передаваемой от периферических рецепторов к спинному мозгу, стволу и областям коры головного мозга, изменениями в нейронной обработке болевых раздражителей и психосоциальных факторов. Это находит отражение в повышенном интересе профессионального сообщества регенеративной медицины к применению высокотехнологических методов нейромодуляции ритмическими электромагнитными импульсами при ХБНЧС. В настоящей первой части обзора представлен систематический анализ накопленных к моменту его публикации литературных данных, которые подтверждают, что ритмическая транскраниальная магнитная стимуляция (рТМС) является патогенетическим терапевтическим методом для таких пациентов, основываясь на экспериментальных и клинических эффектах положительного влияния на искаженную сенсорную передачу, изменение проприоцепции, управление движением и психологическую модуляцию. Методика зарекомендовала себя в кратковременном облегчении хронической дорсалгии, в то время как долгосрочные последствия рТМС (>3 месяцев) должны быть исследованы далее. Для уточнения ее эффективности у пациентов с ХБНЧС требуется последующий набор продуманных РКИ как по дизайну, так и специфике «ослепления» участников. Кроме того, различные факторы, связанные с унификацией пока еще разнородных протоколов стимуляции, включая форму подачи импульсов, частоту, место приложения, регулярность и продолжительность лечения, могут улучшить дальнейшую надлежащую трактовку ее результатов. The aim of this review was to analyze results of studies on the effectiveness of repetitive transcranial and trans-spinal magnetic stimulation (rTMS and rTsMS) in the treatment of low back pain. Chronic low back pain (CLBP) accounts for 22% of all chronic pain cases and 35% of refractory pain syndromes and is complicated by the variability of its manifestations and mechanisms. The low success rate of traditional treatment and rehabilitation of patients with chronic pain does not take into account the cascade of neurophysiological changes (neuroplasticity), including complex interaction between tissue damage, changes in afferent information transmitted from peripheral receptors to spinal cord, brainstem and cortical regions, changes in neural processing of pain stimuli and psychosocial factors. This is reflected in the increased interest of the professional community of regenerative medicine in implementing high-tech methods of neuromodulation by repetitive electromagnetic pulses in CLBP. This first part of the review presents a systematic analysis of the literature data accumulated by the time of its publication, confirming that repetitive transcranial magnetic stimulation (rTMS) is a viable pathogenetic therapeutic method for such patients, based on experimental and clinical positive effects on impaired sensory transmission, changes in proprioception, motor control, and psychological modulation. The method has proven successful in providing short-term relief for chronic dorsalgia, while the long-term effects of rTMS (>3 months) require further investigation. In order to clarify its efficacy in patients with CLBP, a follow-up set of elaborate RCTs is required, both in terms of design and specific «blinding» of participants. In addition, various factors associated with the unification of the still heterogeneous stimulation protocols, including pulse delivery form, frequency, application location, periodicity and treatment duration, may further improve proper result interpretation.

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