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Implantable technology for pain management

      Abstract

      Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact on patients' quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral nerve field. Pharmacological modulation is achieved by directly infusing drugs to the central nervous system. Although neuromodulation has become increasing popular, it is still currently believed to be underused in treating neuropathic pain. This modality has provided us with a non-pharmacological approach to manage patients with neuropathic pain. Patients should have been assessed by a multidisciplinary team before undergoing neuromodulation. This review highlights the present and future management of patients with chronic intractable pain using neuromodulation.

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      References

      1. National Institute for Health and Care Excellence. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin. TA159. 2008. Available from: https://www.nice.org.uk/guidance/ta159

        • Deer T.R.
        • Pope J.E.
        • Hayek S.M.
        • et al.
        The Polyanalgesic Consensus Conference 2017: recommendations on intrathecal drug infusion systems best practices and guidelines.
        Neuromodulation. 2017; 20: 96-132
        • Smits H.
        • van Kleef M.
        • Holsheimer J.
        • et al.
        Experimental spinal cord stimulation and neuropathic pain: mechanism of action, technical aspects, and effectiveness.
        Pain Pract. 2012; 13: 154-168
        • Barchini J.
        • Tchachaghian S.
        • Shamaa F.
        • et al.
        Spinal segmental and supraspinal mechanisms underlying the pain- relieving effects of spinal cord stimulation: an experimental study in a rat model of neuropathy.
        Neuroscience. 2012; 215: 196-208
        • Kapural L.
        • Yu C.
        • Doust M.W.
        • et al.
        Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial.
        Anesthesiology. 2015; 123: 851-860
      2. SCS tool. Available from: https://www.scstool.org/en

        • Thomson S.
        • Huygen F.
        • Prangnell S.
        • et al.
        Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool.
        Eur J Pain. 2020; 24: 1169-1181
        • Liem L.
        • Russo M.
        • Huygen F.J.
        • et al.
        A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain.
        Neuromodulation. 2013; 16: 471-482
        • Deer T.R.
        • Levy R.M.
        • Kramer J.
        • et al.
        Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial.
        Pain. 2016; 158: 669-681
        • Russo M.
        • Brooker C.
        • Cousins M.
        • et al.
        Sustained long-term outcomes with closed-loop spinal cord stimulation: 12-month results of the prospective, multicenter, open-label Avalon study.
        Neurosurgery. 2020; 87: 485-495
        • De Ridder D.
        • Plazier M.
        • Kamerling N.
        • et al.
        Burst spinal cord stimulation for limb and back pain.
        World Neurosurg. 2013; 80 (642.e1–649.e1)
        • Cedeno D.L.
        • Smith W.J.
        • Kelley C.A.
        • et al.
        Spinal cord stimulation using differential target multiplexed programming modulates neural cell-specific transcriptomes in an animal model of neuropathic pain.
        Mol Pain. 2020; 16 (1744806920964360.)
        • Fishman M.
        • Cordner H.
        • Justiz R.
        • et al.
        Twelve-month results from multicenter, open-label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain.
        Pain Pract. 2021; 21: 912-923
        • Reed K.L.
        Peripheral neuromodulation and headaches: history, clinical approach, and considerations on underlying mechanisms.
        Curr Pain Headache Rep. 2013; 17: 305
        • Deckers K.
        • De Smedt K.
        • Mitchell B.
        • et al.
        New therapy for refractory chronic mechanical low back pain-restorative neurostimulation to activate the lumbar multifidus: one year results of a prospective multicenter clinical trial.
        Neuromodulation. 2018; 21: 48-55
      3. Gilligan C, Volschenk W, Russo M, et al. Long-term outcomes of restorative neurostimulation in patients with refractory chronic low back pain secondary to multifidus dysfunction: two-year results of the ReActiv8-B pivotal trial. Neuromodulation 2021; 18: S1094-7159(21)06386-8. Available from: https://doi.org/10.1016/j.neurom.2021.10.011

      4. US Food & Drug Administration. Recently approved devices: Reactiv8 Implantable Neurostimulation System - P190021. Available from: https://www.fda.gov/medical-devices/recently-approved-devices/reactiv8-implantable-neurostimulation-system-p190021