Neurostimulation for Neuropathic Pain: Outcomes and New Paradigms

Srinivasa N. Raja, MD Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore, Md., USA Email: [email protected] Mark Wallace, MD Department of Anesthesiology University of California San Diego, Calif., USA Email: [email protected] N europathic pain afflicts millions of people globally and presents a major health and economic burden. Epidemiological studies carried out with validated screening tools estimate that as many as 7–8% of adults in the general population have pain with neuropathic characteristics. Neuropathic pain can result from various etiologies, such as traumatic or surgical injuries to peripheral nerves, infectious diseases (e.g., herpes zoster, HIV, or leprosy), metabolic disorders, cancer and its treatment, and injuries or diseases that affect the central nervous system (e.g., stroke or spinal cord injury). Nearly a fourth of people with chronic diabetes have neuropathic pain—a worldwide estimate of nearly 50 million individuals. Moreover, neuropathic pain is reported to be more severe than nonneuropathic pain and can dramatically affect health-related quality of life. Several evidence-based recommendations for pharmacological treatments have been published, including a recently updated NeuPSIG recommendation based on a systematic review and meta-analysis of published and unpublished clinical trials. Data from these studies suggest that the management of patients with chronic neuropathic pain is challenging, with more than 50% of patients experiencing only partial or no relief of their pain. In addition, the adverse effects associated with the drugs used to manage the pain may limit their clinical utility, particularly in the elderly population. Hence,