Chronic Pain: Neuromodulation

  • Zoe E. Teton
  • Ahmed M. RaslanEmail author


Chronic pain is one of the most pervasive, debilitating, and expensive conditions encountered by healthcare professionals and faced by patients. Chronic pain treatment is highly varied, increasingly complex, and challenging to healthcare providers. The neurosurgeon possesses a unique set of tools to treat chronic pain, especially when other modalities have failed: neuromodulation. In this chapter the most commonly utilized neuromodulatory techniques are highlighted, and a discussion of efficacy rates, clinical indications, and complications is provided.


Neuromodulation Pain Intracerebroventricular opioids Intrathecal Spinal cord stimulation Deep brain stimulation Motor cortex stimulation Dorsal root ganglion stimulation Peripheral nerve stimulation Occipital neuralgia Occipital nerve stimulation Trigeminal nerve stimulation 


  1. 1.
    Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults — United States, 2016. Morb Mortal Wkly Rep. 2018;67:1001–6.CrossRefGoogle Scholar
  2. 2.
    Farrell SM, Green A, Aziz T. The current state of deep brain stimulation for chronic pain and its context in other forms of neuromodulation. Brain Sci. 2018;8(8):158.CrossRefGoogle Scholar
  3. 3.
    Clark DJ, Schumacher MA. America’s opioid epidemic: supply and demand considerations. Anesth Analg. 2017;125(5):1667–74.CrossRefGoogle Scholar
  4. 4.
    Verrills P, Sinclair C, Barnard A. A review of spinal cord stimulation systems for chronic pain. J Pain Res. 2016;9:481–92.CrossRefGoogle Scholar
  5. 5.
    Boccard SG, Pereira EA, Aziz TZ. Deep brain stimulation for chronic pain. J Clin Neurosci. 2015;22(10):1537–43.CrossRefGoogle Scholar
  6. 6.
    Raslan AM, McCartney S, Burchiel KJ. Management of chronic severe pain: cerebral neuromodulatory and neuroablative approaches. Acta Neurochir Suppl. 2007;97(Pt 2):17–26.CrossRefGoogle Scholar
  7. 7.
    Textor LH. CE: intrathecal pumps for managing cancer pain. Am J Nurs. 2016;116(5):36–44.CrossRefGoogle Scholar
  8. 8.
    Kleinmann B, Wolter T. Intrathecal opioid therapy for non-malignant chronic pain: a long-term perspective. Neuromodulation. 2017;20(7):719–26.CrossRefGoogle Scholar
  9. 9.
    Pendi A, Acosta FL, Tuchman A, et al. Intrathecal morphine in spine surgery: a meta-analysis of randomized controlled trials. Spine (Phila Pa 1976). 2017;42(12):E740–e747.CrossRefGoogle Scholar
  10. 10.
    Raffa RB, Pergolizzi JV Jr. Intracerebroventricular opioids for intractable pain. Br J Clin Pharmacol. 2012;74(1):34–41.CrossRefGoogle Scholar
  11. 11.
    Grider JS, Manchikanti L, Carayannopoulos A, et al. Effectiveness of spinal cord stimulation in chronic spinal pain: a systematic review. Pain Physician. 2016;19(1):E33–54.Google Scholar
  12. 12.
    Simon Thomson M, FRCA, FIPP, FFPMRCA. Spinal cord stimulation: its role in managing chronic disease symptoms. 2016. Accessed 10 Dec 2018.
  13. 13.
    Dones I, Levi V. Spinal cord stimulation for neuropathic pain: current trends and future applications. Brain Sci. 2018;8(8):138.CrossRefGoogle Scholar
  14. 14.
    Miller JP, Eldabe S, Buchser E, Johanek LM, Guan Y, Linderoth B. Parameters of spinal cord stimulation and their role in electrical charge delivery: a review. Neuromodulation. 2016;19(4):373–84.CrossRefGoogle Scholar
  15. 15.
    Chakravarthy K, Richter H, Christo PJ, Williams K, Guan Y. Spinal cord stimulation for treating chronic pain: reviewing preclinical and clinical data on paresthesia-free high-frequency therapy. Neuromodulation. 2018;21(1):10–8.CrossRefGoogle Scholar
  16. 16.
    Kapural L, Yu C, Doust MW, 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(4):851–60.CrossRefGoogle Scholar
  17. 17.
    Taylor RS, Desai MJ, Rigoard P, Taylor RJ. Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: a systematic review and meta-regression analysis. Pain Pract. 2014;14(6):489–505.CrossRefGoogle Scholar
  18. 18.
    Simpson EL, Duenas A, Holmes MW, Papaioannou D, Chilcott J. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation. Health Technol Assess. 2009;13(17):iii, ix–x, 1–154.CrossRefGoogle Scholar
  19. 19.
    Kapural L, Yu C, Doust MW, et al. Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: 24-month results from a multicenter, randomized, controlled pivotal trial. Neurosurgery. 2016;79(5):667–77.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Deer T, Slavin KV, Amirdelfan K, et al. Success using neuromodulation with BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform. Neuromodulation. 2018;21(1):56–66.CrossRefGoogle Scholar
  21. 21.
    Chakravarthy K, Kent AR, Raza A, Xing F, Kinfe TM. Burst spinal cord stimulation: review of preclinical studies and comments on clinical outcomes. Neuromodulation. 2018;21(5):431–9.CrossRefGoogle Scholar
  22. 22.
    Liem L. Stimulation of the dorsal root ganglion. Prog Neurol Surg. 2015;29:213–24.CrossRefGoogle Scholar
  23. 23.
    Deer TR, Levy RM, 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. 2017;158(4):669–81.CrossRefGoogle Scholar
  24. 24.
    Dougherty C. Occipital neuralgia. Curr Pain Headache Rep. 2014;18(5):411.CrossRefGoogle Scholar
  25. 25.
    Keifer OP Jr, Diaz A, Campbell M, Bezchlibnyk YB, Boulis NM. Occipital nerve stimulation for the treatment of refractory occipital neuralgia: a case series. World Neurosurg. 2017;105:599–604.CrossRefGoogle Scholar
  26. 26.
    Sweet JA, Mitchell LS, Narouze S, et al. Occipital nerve stimulation for the treatment of patients with medically refractory occipital neuralgia: congress of neurological surgeons systematic review and evidence-based guideline. Neurosurgery. 2015;77(3):332–41.CrossRefGoogle Scholar
  27. 27.
    Feletti A, Santi GZ, Sammartino F, Bevilacqua M, Cisotto P, Longatti P. Peripheral trigeminal nerve field stimulation: report of 6 cases. Neurosurg Focus. 2013;35(3):E10.CrossRefGoogle Scholar
  28. 28.
    Johnson MD, Burchiel KJ. Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study. Neurosurgery. 2004;55(1):135–41; discussion 141-132.CrossRefGoogle Scholar
  29. 29.
    Bittar RG, Kar-Purkayastha I, Owen SL, et al. Deep brain stimulation for pain relief: a meta-analysis. J Clin Neurosci. 2005;12(5):515–9.CrossRefGoogle Scholar
  30. 30.
    Coffey RJ. Deep brain stimulation for chronic pain: results of two multicenter trials and a structured review. Pain Med. 2001;2(3):183–92.CrossRefGoogle Scholar
  31. 31.
    Owen SL, Green AL, Stein JF, Aziz TZ. Deep brain stimulation for the alleviation of post-stroke neuropathic pain. Pain. 2006;120(1–2):202–6.CrossRefGoogle Scholar
  32. 32.
    Boccard SG, Pereira EA, Moir L, et al. Deep brain stimulation of the anterior cingulate cortex: targeting the affective component of chronic pain. Neuroreport. 2014;25(2):83–8.CrossRefGoogle Scholar
  33. 33.
    Boccard SGJ, Prangnell SJ, Pycroft L, et al. Long-term results of deep brain stimulation of the anterior cingulate cortex for neuropathic pain. World Neurosurg. 2017;106:625–37.CrossRefGoogle Scholar
  34. 34.
    Ostergard T, Munyon C, Miller JP. Motor cortex stimulation for chronic pain. Neurosurg Clin N Am. 2014;25(4):693–8.CrossRefGoogle Scholar
  35. 35.
    Ivanishvili Z, Poologaindran A, Honey CR. Cyclization of motor cortex stimulation for neuropathic pain: a prospective, randomized, blinded trial. Neuromodulation. 2017;20(5):497–503.CrossRefGoogle Scholar
  36. 36.
    Radic JA, Beauprie I, Chiasson P, Kiss ZH, Brownstone RM. Motor cortex stimulation for neuropathic pain: a randomized cross-over trial. Can J Neurol Sci. 2015;42(6):401–9.CrossRefGoogle Scholar
  37. 37.
    Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg. 2009;110(2):251–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Neurological SurgeryOregon Health & Science UniversityPortlandUSA

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