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.

Conflict of interest statement

Competing interests

M.P.J. has published two books on the topic of hypnosis for chronic pain management (Hypnosis for Chronic Pain Management: Therapist Guide and Hypnosis for Chronic Pain Management: Workbook, both published by Oxford University Press), and receives royalties from the sales of these books. M.A.D. and J.M. declare no competing interests.

Figures

Figure 1

Noninvasive brain stimulation and neurofeedback techniques for the treatment of chronic pain. a | Repetitive transcranial magnetic stimulation. b | Transcranial direct current stimulation. c | EEG biofeedback (neurofeedback). Abbreviations: Gnd, ground electrode; Ref, reference electrode.