Neuromodulatory treatments for chronic pain: efficacy and mechanisms

Abstract

Chronic pain is common, and the available treatments do not provide adequate relief for most patients. Neuromodulatory interventions that modify brain processes underlying the experience of pain have the potential to provide substantial relief for some of these patients. The purpose of this Review is to summarize the state of knowledge regarding the efficacy and mechanisms of noninvasive neuromodulatory treatments for chronic pain. The findings provide support for the efficacy and positive side-effect profile of hypnosis, and limited evidence for the potential efficacy of meditation training, noninvasive electrical stimulation procedures, and neurofeedback procedures. Mechanisms research indicates that hypnosis influences multiple neurophysiological processes involved in the experience of pain. Evidence also indicates that mindfulness meditation has both immediate and long-term effects on cortical structures and activity involved in attention, emotional responding and pain. Less is known about the mechanisms of other neuromodulatory treatments. On the basis of the data discussed in this Review, training in the use of self-hypnosis might be considered a viable ‘first-line’ approach to treat chronic pain. More-definitive research regarding the benefits and costs of meditation training, noninvasive brain stimulation and neurofeedback is needed before these treatments can be recommended for the treatment of chronic pain.

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

“…27,28 Research has indicated that MM practice can influence function of the brain areas associated with pain, attention, and emotional response, implicating them as potential mechanisms of action. 29 However, evidence on MM's efficacy for chronic pain is limited and mixed, and MM and CBT interventions have not been sufficiently studied in patients with chronic pain requiring a long-term opioid therapy. 18,19,23,27,28,[30][31][32][33][34][35] A recent randomized controlled trial (RCT) (n = 115) found that a ''mindfulnessoriented recovery enhancement'' intervention, combining MM and CBT, led to decreases in pain severity and opioid desire ratings in adults with opioid-treated chronic pain; however, opioid dose was not quantified in this study.…”

Felnőttkori atopiás dermatitis hipnoterápiás kezelése

“…Ennek az egyszerű megfigyelésnek a klinikai jelentősége óriási lehet olyan kórállapotokban, ahol a keringés mó-dosításával gyulladásos folyamatok válnak befolyásolha-tóvá: Ewin sürgősségi osztályon hipnózissal sikeresen gátolta súlyos égési sérültek bőrelváltozásainak progreszszióját [9]. Hasonló módon (a szubjektív élményvilág és a társuló mikrocirkulációs, inflammatorikus és immunfunkciók módosításával) olyan klinikai problémák javulá-sáról állnak rendelkezésre tanulmányok (a teljesség igé-nye nélkül), mint az akut és krónikus fájdalom, a perioperatív vérvesztés, a kemoterápia asszociálta hányás és hányinger vagy az irritábilis bél szindróma [5,[10][11][12][13]. Mindezek ismeretében talán kevéssé meglepő, hogy egy olyan betegségben, mint az atopiás dermatitis, ahol a gyulladás szintén kulcsszerepet játszik a patogenezisben, hatékony terápiás eszköz lehet a hipnoterápia [14,15].…”

“…Az ismert pszichoterápiás kezelések közül a hipnózis neuromodulatív hatása mind idegélettani, mind klinikai szempontból bizonyítottnak tekinthető [5]. Jelen esetismertetésünkben a hipnózis rövid bemutatását követően a farmakoterápiára csupán minimálisan reagáló, kiterjedt atopiás dermatitises fiatalember hipnoterápiájáról szá-molunk be.…”

Modulation of Pain by Naloxone and a Possible Role of Neurotransmitters with Selective Lesion of Septal Nuclei

“…Studies have described a linear system of pain modulation involving the periaqueductal gray region (PAG) through the rostral ventromedial medulla (RVM) and descending to the spinal cord. We also envision pain as a complex matrix that includes important cortical regions and significant elements of the limbic system as well as the midbrain [4,5].…”

“…hippocampus, cingulate, amygdale and hypothalamus). Septum has been implicated in variety of behaviors like aggression, sexuality and drinking [5][6][7]. Recently a study by Dutta et al indicates that the medial septal glutamate receptors play an important role in the modulation of immune responses [8].…”