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Perspectives

Neuromodulation: what is its place in pain management?

Marc Russo, Nick Christelis

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Abstract

Neuromodulation has an expanding role in chronic pain management. Appropriate patient selection, education, standardised care and attention to detail are crucial for successful outcomes in neuromodulation and to reduce the risks of complications.

Key Points

  • Neuromodulation is the modulation of nerve activity by delivering electrical or pharmaceutical agents directly to a target area.
  • Long-term opioid therapy in chronic noncancer pain has limited efficacy and is associated with significant complications in people with chronic noncancer pain. Alternative management techniques should therefore be considered in these patients.
  • Patients should be considered for referral for spinal cord stimulation if they have ongoing moderate to high levels of persistent neuropathic pain and if more conservative strategies have been comprehensively trialled and failed.
  • Specific indications for consideration for spinal cord stimulation include failed back surgery syndrome, complex regional pain syndrome, peripheral neuropathic pain, chronic peripheral ischaemic pain and refractory angina pectoris.

    Picture credit: © Diomedia

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