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Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 10/2022

08-09-2022 | Ultrasound | Neuromodulation (A Abd-Elsayed, Section Editor)

Advances in Non-Invasive Neuromodulation

Authors: Brian Brenner, Tyler Ericson, Lynn Kohan

Published in: Current Pain and Headache Reports | Issue 10/2022

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Abstract

Purpose of Review

Pain medicine is rapidly expanding. The gap in treatment for patients with chronic pain in between traditional conservative therapy and major invasive surgery is closing. Neuromodulation is one therapeutic area that has continued to show promise for treatment of chronic pain. Our aim is to review updates in non-invasive neuromodulation (NIN) techniques as an adjunct for various chronic pain conditions.

Recent Findings

Overall, the literature suggests that NIN techniques such as tCDS, TMS, TENS, tVNS, and HIFUS/LIFUS have utility in treating various types of chronic pain and have a promising future.

Summary

There is a better understanding of the mechanistic basis for pain relief from NIN, as well as refinement in technology improving NIN therapy success. Future studies will need to focus on continuing to refine protocols for optimal benefit from NIN as well as implementing larger RCTs to improve the quality of data being generated in the field.
Literature
1.
Knotkova H, Hamani C, Sivanesan E, Le Beuffe MFE, Moon JY, Cohen SP, et al. Neuromodulation for chronic pain. The Lancet. 2021;397:2111–24.CrossRef
2.
3.
Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–9.CrossRef
4.
Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns. Anesthesia & Analgesia. 1967;46:489–491.
5.
Nitsche MA, Paulus W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology. 2001;57:1899–901.CrossRef
6.
Woods AJ, Antal A, Bikson M, Boggio PS, Brunoni AR, Celnik P, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol. 2016;127:1031–48.CrossRef
7.
Dalla Volta G, Marceglia S, Zavarise P, Antonaci F. Cathodal tDCS guided by thermography as adjunctive therapy in chronic migraine patients: a sham-controlled pilot study. Front Neurol. 2020;11.
8.
Rahimi MD, Fadardi JS, Saeidi M, Bigdeli I, Kashiri R. Effectiveness of cathodal tDCS of the primary motor or sensory cortex in migraine: a randomized controlled trial. Brain Stimul. 2020;13:675–82.CrossRef
9.
De Icco R, Putortì A, De Paoli I, Ferrara E, Cremascoli R, Terzaghi M, et al. Anodal transcranial direct current stimulation in chronic migraine and medication overuse headache: a pilot double-blind randomized sham-controlled trial. Clin Neurophysiol. 2021;132:126–36.CrossRef
10.
Mariano TY, Burgess FW, Bowker M, Kirschner J, van’t Wout-Frank M, Jones RN, et al. Transcranial direct current stimulation for affective symptoms and functioning in chronic low back pain: a pilot double-blinded, randomized, placebo-controlled trial. Pain Med. 2018;20:1166–77.
11.
• Lloyd DM, Wittkopf PG, Arendsen LJ, Jones AKP. Is transcranial direct current stimulation (tDCS) effective for the treatment of pain in fibromyalgia? A systematic review and meta-analysis. J Pain. 2020;21:1085–100. This study was a well put together meta-analysis looking into the utility of tDCS for fibromyalgia with well supported conclusions and evidence.CrossRef
12.
Bayer K-E, Neeb L, Bayer A, Wiese JJ, Siegmund B, Prüß MS. Reduction of intra-abdominal pain through transcranial direct current stimulation. Medicine. 2019;98: e17017.CrossRef
13.
Young J, Zoghi M, Khan F, Galea MP. The effect of transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis: randomized controlled trial. Pain Med. 2020;21:3451–7.CrossRef
14.
Divandari N, Manshadi FD, Shokouhi N, Vakili M, Jaberzadeh S. Effect of one session of tDCS on the severity of pain in women with chronic pelvic pain. J Bodyw Mov Ther. 2019;23:678–82.CrossRef
15.
Borckardt JJ, Reeves ST, Milliken C, Carter B, Epperson TI, Gunselman RJ, et al. Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use. Brain Stimul. 2017;10:1096–101.CrossRef
16.
Lefaucheur J-P, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017;128:56–92.CrossRef
17.
Thut G, Bergmann TO, Fröhlich F, Soekadar SR, Brittain J-S, Valero-Cabré A, et al. Guiding transcranial brain stimulation by EEG/MEG to interact with ongoing brain activity and associated functions: a position paper. Clin Neurophysiol. 2017;128:843–57.CrossRef
18.
May ES, Hohn VD, Nickel MM, Tiemann L, Ávila CG, Heitmann H, et al. Modulating brain rhythms of pain using transcranial alternating current stimulation (tACS)? A sham-controlled study in healthy human participants [Internet]. Cold Spring Harbor Lab. 2020. Available from: https://​doi.​org/​10.​1101/​2020.​06.​16.​154112.
19.
Pashut T, Wolfus S, Friedman A, Lavidor M, Bar-Gad I, Yeshurun Y, et al. Mechanisms of magnetic stimulation of central nervous system neurons. PLoS Comput Biol. 2011;7: e1002022.CrossRef
20.
Kumar A, Mattoo B, Bhatia R, Kumaran S, Bhatia R. Neuronavigation based 10 sessions of repetitive transcranial magnetic stimulation therapy in chronic migraine: an exploratory study. Neurol Sci. 2020;42:131–9.CrossRef
21.
Tanwar S, Mattoo B, Kumar U, Bhatia R. Repetitive transcranial magnetic stimulation of the prefrontal cortex for fibromyalgia syndrome: a randomized controlled trial with 6-months follow up. Adv Rheumatol. 2020;60.
22.
Imperatore JP, McCalley DM, Borckardt JJ, Brady KT, Hanlon CA. Non-invasive brain stimulation as a tool to decrease chronic pain in current opiate users: a parametric evaluation of two promising cortical targets. Drug Alcohol Depend. 2021;218: 108409.CrossRef
23.
Gatzinsky K, Bergh C, Liljegren A, Silander H, Samuelsson J, Svanberg T, et al. Repetitive transcranial magnetic stimulation of the primary motor cortex in management of chronic neuropathic pain: a systematic review. Scand J Pain. 2020;21:8–21.CrossRef
24.
Johnson M. Transcutaneous electrical nerve stimulation: mechanisms, clinical application and evidence. Rev Pain. 2007;1:7–11.CrossRef
25.
Sabino GS, Santos CMF, Francischi JN, de Resende MA. Release of endogenous opioids following transcutaneous electric nerve stimulation in an experimental model of acute inflammatory pain. J Pain. 2008;9:157–63.CrossRef
26.
Chou DE, Shnayderman Yugrakh M, Winegarner D, Rowe V, Kuruvilla D, Schoenen J. Acute migraine therapy with external trigeminal neurostimulation (ACME): a randomized controlled trial. Cephalalgia. 2018;39:3–14.CrossRef
27.
Wu L-C, Weng P-W, Chen C-H, Huang Y-Y, Tsuang Y-H, Chiang C-J. Literature review and meta-analysis of transcutaneous electrical nerve stimulation in treating chronic back pain. Reg Anesth Pain Med. 2018;43:425–33.CrossRef
28.
•• Todd N, McDannold N, Borsook D. Targeted manipulation of pain neural networks: the potential of focused ultrasound for treatment of chronic pain. Neurosci Biobehav Rev. 2020;115:238–50. The study provides a strong background, mechanistic rationale, and future indications and potentials for focused ultrasound in the realm of pain medicine.CrossRef
29.
Elias WJ, Huss D, Voss T, Loomba J, Khaled M, Zadicario E, et al. A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2013;369:640–8.CrossRef
30.
Mainprize T, Lipsman N, Huang Y, Meng Y, Bethune A, Ironside S, et al. Blood-brain barrier opening in primary brain tumors with non-invasive MR-guided focused ultrasound: a clinical safety and feasibility study. Sci Rep. 2019;9.
31.
Lee W, Kim H, Jung Y, Song I-U, Chung YA, Yoo S-S. Image-guided transcranial focused ultrasound stimulates human primary somatosensory cortex. Sci Rep. 2015;5.
32.
Martin E, Jeanmonod D, Morel A, Zadicario E, Werner B. High-intensity focused ultrasound for noninvasive functional neurosurgery. Ann Neurol. 2009;66:858–61.CrossRef
33.
Jeanmonod D, Werner B, Morel A, Michels L, Zadicario E, Schiff G, et al. Transcranial magnetic resonance imaging–guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain. Neurosurg Focus. 2012;32:E1.CrossRef
34.
35.
36.
Namba H, Kawasaki M, Izumi M, Ushida T, Takemasa R, Ikeuchi M. Effects of MRgFUS treatment on musculoskeletal pain: comparison between bone metastasis and chronic knee/lumbar osteoarthritis. Pain Res Manage. 2019;2019:1–7.CrossRef
37.
38.
39.
Kohan L, FUSmobile. Can FUS treatment of the sacroiliac region reduce pain? Phase I clinical trial: safety and efficacy of the neurolyser XR for the treatment of low back pain related to sacroiliitis.
40.
Kaye EA, Maybody M, Monette S, Solomon SB, Gulati A. Ablation of the sacroiliac joint using MR-guided high intensity focused ultrasound: a preliminary experiment in a swine model. J Ther Ultrasound. 2017;5.
41.
Morris GL, Mueller WM. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. Neurology. 1999;53:1731–1731.CrossRef
42.
Rush AJ, Sackeim HA, Marangell LB, George MS, Brannan SK, Davis SM, et al. Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiat. 2005;58:355–63.CrossRef
43.
Ben-Menachem E, Revesz D, Simon BJ, Silberstein S. Surgically implanted and non-invasive vagus nerve stimulation: a review of efficacy, safety and tolerability. Eur J Neurol. 2015;22:1260–8.CrossRef
44.
Butt MF, Albusoda A, Farmer AD, Aziz Q. The anatomical basis for transcutaneous auricular vagus nerve stimulation. J Anat. 2020;236:588–611.CrossRef
45.
• Yap JYY, Keatch C, Lambert E, Woods W, Stoddart PR, Kameneva T. Critical review of transcutaneous vagus nerve stimulation: challenges for translation to clinical practice. Front Neurosci. 2020;14. The study provides excellent background, anatomic, and clinical indications for tVNS as well as a thorough dissection of the known benefits, pitfalls, and future indications for tVNS.
46.
Vonck K, De Herdt V, Boon P. Vagal nerve stimulation — a 15-year survey of an established treatment modality in epilepsy surgery. Adv Tech Stand Neurosurg. 2009;34:111–46.CrossRef
47.
Krahl SE, Senanayake SS, Handforth A. Destruction of peripheral C-fibers does not alter subsequent vagus nerve stimulation-induced seizure suppression in rats. Epilepsia. 2001;42:586–9.CrossRef
48.
Safi S, Ellrich J, Neuhuber W. Myelinated axons in the auricular branch of the human vagus nerve. Anat Rec. 2016;299:1184–91.CrossRef
49.
Zhang Y, Huang Y, Li H, Yan Z, Zhang Y, Liu X, et al. Transcutaneous auricular vagus nerve stimulation (taVNS) for migraine: an fMRI study. Reg Anesth Pain Med. 2020;46:145–50.CrossRef
50.
Aranow C, Atish-Fregoso Y, Lesser M, Mackay M, Anderson E, Chavan S, et al. Transcutaneous auricular vagus nerve stimulation reduces pain and fatigue in patients with systemic lupus erythematosus: a randomized, double-blind, sham-controlled pilot trial. Ann Rheum Dis. 2020;80:203–8.CrossRef
51.
Muthulingam JA, Olesen SS, Hansen TM, Brock C, Drewes AM, Frøkjær JB. Study protocol for a randomized double-blinded, sham-controlled, prospective, cross-over clinical trial of vagal neuromodulation for pain treatment in patients with chronic pancreatitis. BMJ Open. 2019;9: e029546.CrossRef
52.
Natelson BH, Stegner AJ, Lange G, Khan S, Blate M, Sotolongo A, et al. Vagal nerve stimulation as a possible non-invasive treatment for chronic widespread pain in Gulf Veterans with Gulf War Illness. Life Sci. 2021;282: 119805.CrossRef
53.
Barash P, Cullen BF, Stoelting RK, Cahalan M, Stock MC, Ortega R. Handbook of clinical anesthesia. Lippincott Williams & Wilkins; 2013.
Metadata
Title
Advances in Non-Invasive Neuromodulation
Authors
Brian Brenner
Tyler Ericson
Lynn Kohan
Publication date
08-09-2022
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 10/2022
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-022-01081-3

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