Nerve stimulation for chronic pain

INS recruited 60 neurostimulation experts from around the world to review the current literature and provide expert advice on how to properly treat chronic pain. The panel noted that nerve stimulation is clinically effective and cost-effective, but it is not used correctly in many patients with chronic pain.

According to Dr. Thomson, chief consultant of the pain management center, some doctors now prefer conservative treatment to avoid potential complications. He told Medpage Medical News, Meilun"this can leave some patients with excruciating pain that shouldn't be there."

Unfortunately, current guidelines for nerve stimulation are often polarized depending on the author's professional or political background. And current guidelines or consensus cannot comment on all neuromodulation patterns.

The committee made it clear that the right treatment of spinal/peripheral nerve stimulation could change the lives of many patients. Improved techniques and clinical evidence will expand the use of appropriate nerve stimulation, which is safe and effective for many patients with slower pain.

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Spinal cord stimulation (SCS), since its introduction, has been widely used in the treatment of chronic pain. The FDA approves electrical stimulation of the spinal cord to treat chronic pain in Meilunthe trunk and extremities, such as failed lumbar surgery syndrome, complex regional pain syndrome, and nerve root disease. SCS are also used for other neurological syndromes such as traumatic or diabetic neuropathy and postherpetic neuralgia. For head and neck diseases, the panel believes that if possible, extracranial stimulation should be an early treatment option.

Intracranial nerve stimulation has potentially helped many patients, but the use of deep brain stimulation (DBS) meron is limited because of its inherent invasive nature and risk. "If possible, we should try to find targets outside the skull to treat pain," the panel wrote. "We want to make sure we use the least invasive but effective treatment," Dr. Thomson said. DBS is not the best way to treat pain except for a specific pain, such as facial pain caused by trigeminal nerve injury, and it lacks clinical randomized trials to validate it.

Peripheral nerve electrical stimulation (PNS) has been shown to be successful in treating migraines and other headache symptoms. The committee recommended that PNS treatment of the extracranial nerve (the greater occipital nerve) be used earlier for pain treatment, before long-term, long-acting opioid pain medications can be introduced. "There is good evidence that extracranial stimulation can help treat chronic migraine," Dr. Thomson said. So we want to make sure that it is firmly established in the treatment."

The side effects caused by SCS and PNS are mainly hardware-related (electrode issues, etc.). "Broken electrodes and dislocated electrodes may be common in electrical stimulation of the spinal cord," Dr. Thomson said. Therefore, researchers are working to improve electrode duration and anchoring ability."

The main biologically related complication is infection, while serious side effects may involve neurological damage. Experts were most concerned about nerve damage from epidural hematomas, but such cases were very rare. However, once the implant surgeon is inexperienced and poorly trained (SCS/PNS operation), complications will increase, so standardized training is crucial.

In addition, permanent implants should be performed in an environment with adequate medical facilities, not just simple offices or clinics, and should at least meet the same aseptic environmental standards as hospitals or surgical centers.

Finally, in view of the rapid development of research in the field of neural stimulation, the expert group decided to conduct a review of relevant issues every two years.