Neuromodulation for pain treatment

Abstract

Neuromodulation includes surgical approaches such as deep brain stimulation (DBS), spinal cord stimulation (SCS), and motor cortex stimulation (MCS), as well as non-invasive methods including repetitive transcranial magnetic stimulation (rTMS), transcranial electrical stimulation, and transcranial focused ultrasound stimulation (TUS/tFUS). For the treatment of intractable pain, SCS typically targets the dorsal columns and dorsal horn, while DBS commonly targets the ventroposterior nucleus of the thalamus and the periaqueductal gray matter. rTMS applied to the primary motor cortex has been introduced as a non-invasive alternative to MCS, and numerous randomized controlled trials have been conducted. More recently, DBS, rTMS, and TUS/tFUS targeting the ventral striatum and anterior limb of the internal capsule, medial thalamic nuclei, insular cortex, and anterior cingulate cortex have also been explored. Advances in the understanding of the functional localization and neural circuits of the central nervous system involved in pain perception, together with technological innovations in neuromodulation, are expected to lead to the development of novel therapeutic approaches.