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Non pharmacological treatment for neuropathic pain: Invasive and non-invasive cortical stimulation.
Rev Neurol (Paris). 2019 Jan - Feb; 175(1-2):51-58.RN

Abstract

The use of medications in chronic neuropathic pain may be limited with regard to efficacy and tolerance. Therefore, non-pharmacological approaches, using electrical stimulation of the cortex has been proposed as an alternative. First, in the early nineties, surgically-implanted epidural motor cortex stimulation (EMCS) was proven to be effective to relieve refractory neuropathic pain. Later, non-invasive stimulation techniques were found to produce similar analgesic effects, at least by means of repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1). Following "high-frequency" rTMS (e.g., stimulation frequency ranging from 5 to 20Hz) delivered to the precentral gyrus (e.g., M1 region), it is possible to obtain an analgesic effect via the modulation of several remote brain regions involved in nociceptive information processing or control. This pain reduction can last for weeks beyond the time of the stimulation, especially if repeated sessions are performed, probably related to processes of long-term synaptic plasticity. Transcranial direct current stimulation (tDCS), another form of transcranial stimulation, using low-intensity electrical currents, generally delivered by a pair of large electrodes, has also shown some efficacy to improve patients with chronic pain syndromes. The mechanism of action of tDCS differs from that of EMCS and rTMS, but the cortical target is the same, which is M1. Although the level of evidence of therapeutic efficacy in the context of neuropathic pain is lower for tDCS than for rTMS, interesting perspectives are opened by using at-home tDCS protocols for long-term management. Now, there is a scientific basis for recommending both EMCS and rTMS of M1 to treat refractory chronic neuropathic pain, but their application in clinical practice remains limited due to practical and regulatory issues.

Authors+Show Affiliations

Inserm, service de neurologie Clermont-Ferrand, université Clermont-Auvergne, Neuro-Dol, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France. Electronic address: xavier.moisset@gmail.com.Service de physiologie, explorations fonctionnelles, EA 4391, faculté de médecine, université Paris Est Créteil, 94000 Créteil, France; Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30322590

Citation

Moisset, X, and J-P Lefaucheur. "Non Pharmacological Treatment for Neuropathic Pain: Invasive and Non-invasive Cortical Stimulation." Revue Neurologique, vol. 175, no. 1-2, 2019, pp. 51-58.
Moisset X, Lefaucheur JP. Non pharmacological treatment for neuropathic pain: Invasive and non-invasive cortical stimulation. Rev Neurol (Paris). 2019;175(1-2):51-58.
Moisset, X., & Lefaucheur, J. P. (2019). Non pharmacological treatment for neuropathic pain: Invasive and non-invasive cortical stimulation. Revue Neurologique, 175(1-2), 51-58. https://doi.org/10.1016/j.neurol.2018.09.014
Moisset X, Lefaucheur JP. Non Pharmacological Treatment for Neuropathic Pain: Invasive and Non-invasive Cortical Stimulation. Rev Neurol (Paris). 2019 Jan - Feb;175(1-2):51-58. PubMed PMID: 30322590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non pharmacological treatment for neuropathic pain: Invasive and non-invasive cortical stimulation. AU - Moisset,X, AU - Lefaucheur,J-P, Y1 - 2018/10/12/ PY - 2018/07/19/received PY - 2018/09/10/accepted PY - 2018/10/17/pubmed PY - 2019/6/4/medline PY - 2018/10/17/entrez KW - Brain stimulation KW - Motor cortex stimulation KW - Neuropathic pain KW - Transcranial electrical stimulation KW - Transcranial magnetic stimulation SP - 51 EP - 58 JF - Revue neurologique JO - Rev Neurol (Paris) VL - 175 IS - 1-2 N2 - The use of medications in chronic neuropathic pain may be limited with regard to efficacy and tolerance. Therefore, non-pharmacological approaches, using electrical stimulation of the cortex has been proposed as an alternative. First, in the early nineties, surgically-implanted epidural motor cortex stimulation (EMCS) was proven to be effective to relieve refractory neuropathic pain. Later, non-invasive stimulation techniques were found to produce similar analgesic effects, at least by means of repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1). Following "high-frequency" rTMS (e.g., stimulation frequency ranging from 5 to 20Hz) delivered to the precentral gyrus (e.g., M1 region), it is possible to obtain an analgesic effect via the modulation of several remote brain regions involved in nociceptive information processing or control. This pain reduction can last for weeks beyond the time of the stimulation, especially if repeated sessions are performed, probably related to processes of long-term synaptic plasticity. Transcranial direct current stimulation (tDCS), another form of transcranial stimulation, using low-intensity electrical currents, generally delivered by a pair of large electrodes, has also shown some efficacy to improve patients with chronic pain syndromes. The mechanism of action of tDCS differs from that of EMCS and rTMS, but the cortical target is the same, which is M1. Although the level of evidence of therapeutic efficacy in the context of neuropathic pain is lower for tDCS than for rTMS, interesting perspectives are opened by using at-home tDCS protocols for long-term management. Now, there is a scientific basis for recommending both EMCS and rTMS of M1 to treat refractory chronic neuropathic pain, but their application in clinical practice remains limited due to practical and regulatory issues. SN - 0035-3787 UR - https://www.unboundmedicine.com/medline/citation/30322590/Non_pharmacological_treatment_for_neuropathic_pain:_Invasive_and_non_invasive_cortical_stimulation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0035-3787(18)30755-0 DB - PRIME DP - Unbound Medicine ER -