Non-invasive Brain Stimulation for Chronic Pain: State of the Art and Future Directions

Abstract

As a technique that can guide brain plasticity, non-invasive brain stimulation (NIBS) has the potential to improve the treatment of chronic pain (CP) because it can interfere with ongoing brain neural activity to regulate specific neural networks related to pain management. Treatments of CP with various forms of NIBS, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), using new parameters of stimulation have achieved encouraging results. Evidence of moderate quality indicates that high-frequency rTMS of the primary motor cortex has a clear effect on neuropathic pain (NP) and fibromyalgia. However, evidence on its effectiveness regarding pain relief in other CP conditions is conflicting. Concerning tDCS, evidence of low quality supports its benefit for CP treatment. However, evidence suggesting that it exerts a small treatment effect on NP and headaches is also conflicting. In this paper, we describe the underlying principles behind these commonly used stimulation techniques; and summarize the results of randomized controlled trials, systematic reviews, and meta-analyses. Future research should focus on a better evaluation of the short-term and long-term effectiveness of all NIBS techniques and whether they decrease healthcare use, as well as on the refinement of selection criteria.

Noninvasive Brain Stimulation for Cancer Pain Management in Nonbrain Malignancy: A Meta-Analysis

“…Nociceptive stimulation activates glutamate NMDA receptors, leading to calcium infux, and triggering the calcium-dependent intracellular pathway to induce LTP, notably the calcium/calmodulin-dependent protein kinase II (CaMKII) pathway [9,39]. LTP was shown to be associated with the analgesic mechanisms in NIBS [40]. It has been reported that rTMS reduces central sensitization by 70% according to the central sensitization inventory score [41].…”

Efficacy of repetitive transcranial magnetic stimulation on chronic migraine: A meta-analysis

“…Non-invasive brain stimulation (NiBS) technology has been regarded as an important innovation in neuropsychiatric diseases and chronic pain (including migraine) in recent years and widely used in clinical settings (10)(11)(12)(13). Transcranial magnetic stimulation (TMS), which applied a magnetic field to the surface of the scalp and induces current in the subjacent cortex (14), is an effective and safe approach that has been approved by the FDA for migraine treatment (15, 16).…”

Non-invasive brain stimulation for osteoarthritis

“…Bioelectronic medicine uses the body’s electrical signals to improve the diagnosis and treatment of disease. As an emerging bioelectronic medical technology, Non-invasive brain stimulation (NIBS) has been widely used in clinical treatment, particularly for pain ( Xiong et al, 2022 ), neuronal function regulation, brain function cognition, behavior, and other aspects of the evident treatment effect ( Miniussi and Ruzzoli, 2013 ). NIBS not only brings hope for treating diseases that cannot be solved by common drugs and medical means, but also provides drug alternatives with rapid and precise targeting.…”