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Neuromodulation for chronic pain
Indexado
WoS WOS:000656257800029
Scopus SCOPUS_ID:85107435940
DOI 10.1016/S0140-6736(21)00794-7
Año 2021
Tipo revisión

Citas Totales

Autores Afiliación Chile

Instituciones Chile

% Participación
Internacional

Autores
Afiliación Extranjera

Instituciones
Extranjeras


Abstract



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

Revista



Revista ISSN
Lancet 0140-6736

Métricas Externas



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Disciplinas de Investigación



WOS
Medicine, General & Internal
Scopus
Medicine (All)
SciELO
Sin Disciplinas

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Publicaciones WoS (Ediciones: ISSHP, ISTP, AHCI, SSCI, SCI), Scopus, SciELO Chile.

Colaboración Institucional



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Autores - Afiliación



Ord. Autor Género Institución - País
1 Knotkova, Helena Mujer MJHS Inst Innovat Palliat Care - Estados Unidos
Albert Einstein Coll Med - Estados Unidos
MJHS Institute for Innovation in Palliative Care - Estados Unidos
Albert Einstein College of Medicine of Yeshiva University - Estados Unidos
Albert Einstein College of Medicine - Estados Unidos
2 Hamani, Clement Hombre UNIV TORONTO - Canadá
University of Toronto - Canadá
3 Sivanesan, Eellan - Johns Hopkins Sch Med - Estados Unidos
Johns Hopkins School of Medicine - Estados Unidos
Johns Hopkins University School of Medicine - Estados Unidos
4 Elgueta Le Beuffe, Maria Francisca Mujer Pontificia Universidad Católica de Chile - Chile
4 Le Beuffe, María Francisca Elgueta Mujer Pontificia Universidad Católica de Chile - Chile
5 Moon, Jee Youn - Seoul Natl Univ - Corea del Sur
Seoul National University - Corea del Sur
6 Cohen, Steven P. Hombre Johns Hopkins Sch Med - Estados Unidos
UNIFORMED SERV UNIV HLTH SCI - Estados Unidos
Johns Hopkins School of Medicine - Estados Unidos
Uniformed Services University of the Health Sciences - Estados Unidos
F. Edward Hebert School of Medicine - Estados Unidos
Johns Hopkins University School of Medicine - Estados Unidos
7 Huntoon, Marc A. Hombre Virginia Commonwealth Univ - Estados Unidos
Virginia Commonwealth University - Estados Unidos
VCU School of Medicine - Estados Unidos

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Financiamiento



Fuente
National Institutes of Health
U.S. Department of Defense
US Department of Defense
Department of Physical Medicine AMP; Rehabilitation, Uniformed Services University
Musculoskeletal Injury Rehabilitation Research for Operational Readiness
Uniformed Services University of the Health Sciences
Scilex & Avanos
Soterix Medical

Muestra la fuente de financiamiento declarada en la publicación.

Agradecimientos



Agradecimiento
This work was partly supported (partial effort for SPC paid to Johns Hopkins) by the Musculoskeletal Injury Rehabilitation Research for Operational Readiness, Department of Physical Medicine & Rehabilitation, Uniformed Services University, US Department of Defense (HU00011920011). This organisation played no role in the preparation of this manuscript.
SPC has served as a consultant for Avanos, Department of Justice, Persica, and SPR Therapeutics, and his institutions have received grant funding from Scilex & Avanos (Johns Hopkins) and SPR Therapeutics (Walter Reed), including National Institutes for Health funding (1 UH3135804, U24NS115708, R01DA048206–01, and GR101558). MAH served as a consultant for Mainstay Medical, Saluda, and SPR Therapeutics. HK received research supplies from Soterix Medical and National Institutes for Health funding (1 R01 AG068167–01). CH was on the advisory board for Medtronic.

Muestra la fuente de financiamiento declarada en la publicación.