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

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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.

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