Chronic pain, which persists despite the fact that an injury has healed, can last for many months or years and may affect up to 15 percent of the adult population at any point in time. While it is a condition in its own right, it can be a component of other conditions. Neurostimulation, which involves stimulating pain-sensing nerves to convert painful sensations into nonpainful ones, offers a minimally invasive and reversible alternative to medication. A new report from an international team of experts provides comprehensive information on the safety and effectiveness of this type of treatment for conditions including failed back surgery syndrome and complex regional pain syndrome. More studies are needed for conditions such as peripheral neuropathic pain, postamputation pain and nerve pain from shingles.
The report was published online on Aug. 12 in Neuromodulation: Technology at the Neural Interface and will be published in print on Aug. 15.
"Spinal cord stimulation, one of the more commonly used methods of neurostimulation treatment, has evolved quite a bit since it was introduced into clinical practice in the late 1960s," says Kayode Williams, M.D., M.B.A., medical director of the Blaustein Pain Treatment Center at The Johns Hopkins Hospital. The technology is used to treat conditions including neuropathic pain, complex regional pain syndrome, failed back surgery syndrome, postherpetic neuralgia and phantom limb pain.
To determine the safety and effectiveness of neurostimulation to treat chronic pain, Williams and his colleagues on the International Neuromodulation Society's Neuromodulation Appropriateness Consensus Committee evaluated literature reviews, expert opinions, clinical experience and individual research reports on the topic.
"This is the first article of its kind to provide evidence-based guidance for all stakeholders worldwide involved in the treatment of chronic pain regarding the appropriateness of spinal cord stimulation and peripheral nerve stimulation," says Williams. "We hope it will enhance the development of a worldwide consensus as to how best to employ these treatment modalities in an ever-growing population of patients suffering from chronic pain."
The experts noted that unlike alternative therapies, neurostimulation is not linked with medication-related side effects, and it has an enduring effect. Complications related to neurostimulation devices are not uncommon; however, their incidence is becoming less frequent as technology progresses and surgical skills improve.
The panel will update its recommendations in the future, and it encourages physicians who use neurostimulation to strive to provide the best and most informed care possible in this quickly evolving and exciting area of medicine.
In a separate Neuromodulation paper, the International Neuromodulation Society selected members of the international scientific community to analyze scientific evidence for current and future innovations related to neurostimulation and to use clinical experience to fill in any gaps in information. The experts determined that currently approved neurostimulation techniques and technologies have expanded physicians' ability to treat patients in a more effective and specific fashion. However, there are several additional promising technologies and potential applications for neurostimulation that could move this field forward and expand its applicability. For example, neurostimulation therapy may be able to help treat a number of nonpain states, including obesity, Alzheimer's disease, obsessive compulsive disorder and addiction.
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