Indian Journal of Pain

EDITORIAL
Year
: 2022  |  Volume : 36  |  Issue : 1  |  Page : 1--2

Emerging noninvasive therapies in pain management


Hammad Usmani1, Tariq Mansoor2, Nazia Tauheed1,  
1 Department of Anaesthesiology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
2 Vice Chancellor, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Correspondence Address:
Prof. Hammad Usmani
Consultant Incharge, Pain Clinic, Department of Anaesthesiology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh
India




How to cite this article:
Usmani H, Mansoor T, Tauheed N. Emerging noninvasive therapies in pain management.Indian J Pain 2022;36:1-2


How to cite this URL:
Usmani H, Mansoor T, Tauheed N. Emerging noninvasive therapies in pain management. Indian J Pain [serial online] 2022 [cited 2022 May 28 ];36:1-2
Available from: https://www.indianjpain.org/text.asp?2022/36/1/1/343826


Full Text



Although the history of noninvasive pain management is as old as humankind, evidence date back to the 2nd century AD, when the Roman physician Scribonius Largus identified that electric current had analgesic properties, instructing patients to stand on an electric ray, the live black torpedo, for the treatment of gout.[1] Nearly 2 millennia later, in 2014, transcranial magnetic stimulation (TMS) was approved by the National Institute for Health and Care Excellence (NICE) for the management of migraine.[2]

Pain management techniques, in terms of the degree of intervention, can be broadly classified into noninvasive nondrug techniques, noninvasive pharmacological techniques, and invasive pain management. Noninvasive modalities for pain management currently include an array of procedures.

Although oral/topical medications are also included in noninvasive treatment modalities, the trend now is shifting to focus more on noninvasive and nonpharmacological modalities. This is so because long-term pharmacologic measures carry with the term associated problems of tolerance, intolerance, and adverse effects. Skelly et al.,[3] in their systematic review, have analyzed the use of exercise, massage, low-level laser therapy, acupuncture, hot and cold therapies, and transcutaneous electrical nerve stimulation (TENS) as noninvasive nonpharmacological interventions for pain management.

The emerging relief modes for acute and chronic pain, most if not all, are based on the science of neuromodulation, technologies that impact on neural surfaces to improve human life. Laser, electric currents, magnetic stimulations, and off-late distraction techniques with a wide range of variations can be observed uprising. Although these technologies, in their higher energy levels, have been in use since long for the management of psychiatric disorders, their role in pain management is being realized and the technologies, thus, being harvested.

Devices to curb pain using neuromodulation techniques are being developed; Cefaly a TENS device, was the first of its kind with the Food and Drug Administration approval and is in use for nearly a decade.[4] It employs tiny electrical impulses to the trigeminal nerve and plays a role primarily in the prevention of migraine. The device, Stimpod NMS460 (Xavant technology, Pretoria, South Africa) applies hybrid pulsed radiofrequency waves to the nerve causing percutaneous peripheral nerve stimulation. The device is user-friendly, safe, and well-tolerated and thus taking an increasing place as an adjunct therapy in acute as well as chronic pain conditions including chronic headache.[5]

A systematic review[6] on TMS found it to be effective for short-term pain relief, devoid of any serious complications, but the long-term effects on pain relief (>3 months) need further investigations. The National Institute for NICE 2021 guidelines state that the limited evidence on laser therapy and TMS are promising, and the committee agreed to make recommendations for research on these procedures for chronic primary pain.[7]

Transcranial direct current stimulation has proved safety and efficacy in depressive disorders,[8] and with upcoming research, its role in chronic pain management is also being established. Trials for its use in poststroke pain and complex regional pain syndrome have started within this very decade with promising results in terms of its efficacy and safety.[9],[10]

Immersive virtual reality (VR) therapy, a distraction technique, also deserves special mention, a potential technology for the multidisciplinary health-care team. A systematic review on the use of VR in the treatment of burns showed that this technology combined with pharmacological analgesics contributes to the reduction of pain and anxiety.[11] Results from studies[12] point to the benefits of VR in relation to increased distraction, which facilitates care, such as dressing changes and physiotherapy in burn patients. It has been found to be of benefit in other pain conditions also such as phantom limb pain, poststroke pain, and neuropathic pain.[13]

Currently, the brunt of most of the research on these beneficial procedures is borne by researchers abroad. With enlightened minds and no less expertise, our flag bearers in the field need to invigorate with no less stirring to walk at a similar pace sharing the burden of exploration and fact-finding.

References

1Francis J, Dingley J. Electroanaesthesia – From torpedo fish to TENS. Anaesthesia 2015;70:93-103.
2National Institute for Health and Care Excellence (NICE). Transcranial Magnetic Stimulation for Treating and Preventing Migraine. NICE Interventional Procedures Guidance [IPG477]; 2014. Available from: http://www.nice.org.uk/guidance/IPG477. [Last accessed on 2022 Mar 21].
3Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020.
4Available from: https://www.accessdata.fda.gov/cdrh_docs/reviews/K122566.pdf. [Last accessed on 2022 Mar 21].
5Tauheed N, Usmani H, Afzal H, Zafar L, Hussain A. Noninvasive neuromodulation of supraorbital and occipital nerves as an adjunct to management of chronic headache: A pilot study. Indian J Pain 2019;33:20-4.
6Yang S, Chang MC. Effect of repetitive transcranial magnetic stimulation on pain management: A systematic narrative review. Front Neurol 2020;11:114.
7Available from: https://www.nice.org.uk/process/pmg6/resources/the-guidelines-manual-pdf-2007970804933. [Last accessed on 2022 Mar 21].
8Brunoni AR, Moffa AH, Fregni F, Palm U, Padberg F, Blumberger DM, et al. Transcranial direct current stimulation for acute major depressive episodes: Meta-analysis of individual patient data. Br J Psychiatry 2016;208:522-31.
9Ramger BC, Bader KA, Davies SP, Stewart DA, Ledbetter LS, Simon CB, et al. Effects of non-invasive brain stimulation on clinical pain intensity and experimental pain sensitivity among individuals with central post-stroke pain: A systematic review. J Pain Res 2019;12:3319-29.
10Lagueux É, Bernier M, Bourgault P, Whittingstall K, Mercier C, Léonard G, et al. The effectiveness of transcranial direct current stimulation as an add-on modality to graded motor imagery for treatment of complex regional pain syndrome: A randomized proof of concept study. Clin J Pain 2018;34:145-54.
11Morris LD, Louw QA, Grimmer-Somers K. The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: A systematic review. Clin J Pain 2009;25:815-26.
12Maani CV, Hoffman HG, Morrow M, Maiers A, Gaylord K, McGhee LL, et al. Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. J Trauma 2011;71:S125-30.
13Ortiz-Catalan M, Sander N, Kristoffersen MB, Håkansson B, Brånemark R. Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: A case study of a chronic PLP patient. Front Neurosci 2014;8:24.