About this Research Topic
Pain is a universal human experience and a common morbidity shared by innumerable diseases. The cerebral localization of the perception of pain remains unclear, though strong evidence suggests the involvement for the insula, cingulate, and thalamus. Perhaps due in part to this limited understanding of the circuitry underlying pain perception, cerebral neuromodulation, has yet to show consistent clinical applications.
Given that a considerable proportion of chronic patients fail to achieve sustained pain relief, alternative non-pharmacological strategies such as non-invasive/invasive neuromodulation approaches emerged as an adjunctive and synergistic treatment option. Despite the observed clinical effects of invasive/non-invasive neurostimulation therapies (brain, spinal cord, peripheral nervous system) in chronic pain, quantitative outcome measures using electrophysiology, imaging, molecular profiling, digital phenotyping, artificial intelligence and deep machine learning are in the beginning of a long roadmap towards a personalized medicine in chronic pain management. To date, neurostimulation therapies are mostly quantified using subjective patient-specific scores, which may considerably confound the reported results due to the heterogenic character of chronic pain disorders. Chronic pain associated co-morbidities, such as psychiatric alteration, disturbed sleep architecture, anxiety disorders, somatization, cognitive impairment, demographic and environmental/life style factors, may bias proper patient selection and appropriate neurostimulation therapy. Given the inconsistent findings in earlier studies and poor level of evidence, future targeted neuromodulation research should attempt to integrate these potential and objective outcome parameters to neuromodulation outcome.
Undoubtedly, the inter- and intra-individual variability (heterogeneity in diagnosis and therapy) of patients suffering from chronic pain remains an unmet issue in the field of applied invasive/non-invasive neurostimulation and pain management. It is unclear to what extent it may impact patient selection and treatment responsiveness, and therefore different outcome parameters should be investigated. These may include molecular assay of inflammation, structural/functional neuroimaging, neurophysiological assessment (e.g. EEG, MEG, QST) and/or computational modeling. It is noteworthy that these mentioned modalities will influence both diagnostic and treatment performance (device, stimulation setting, target, duration), and will help to better understand variations in chronic pain phenotypes (enhanced patient selection), treatment outcome (responder versus non-responder) and stratification of standardized stimulation protocols. Thus, the concept of a personalized and predictive neurostimulation therapy, based on a comprehensive, pre-implant assessment of objective measures, represents the next step in clinical neuromodulation pain research.
For this Research Topic we welcome submissions of Original Research and Review Articles addressing, but not limited to, the following topics:
• Animal models for human chronic pain;
• Localization of pain networks;
• Electrophysiological markers of acute and chronic pain;
• Imaging markers for acute and chronic pain;
• New techniques for the experimental manipulation of painful stimuli;
• Neurostimulation treatments for chronic pain - using invasive and non-invasive approaches;
• Cerebral lesioning approaches for treating chronic pain;
• Non-stimulation based therapies for chronic pain (e.g., VR and mirror therapy);
• Assessing treatment outcome using measures such as structural/functional neuroimaging, electrophysiology (MEG, EEG, LEP), molecular biology of neuroinflammation (genetic, epigenetic), computational/modeling science and digital phenotyping;
• Ethics of neuromodulation for pain.
Topic Editor John Rolston holds stock in Axion Biosystems. Krishnan Chakravarthy is the co-founder of NanoAxis. Timothy Deer received research support from Abbott, Saluda, Mainstay, and Vertiflex and has equity in Axonics, Bioness, Ethos, Saluda, Nalu, Cornerloc, Spinethera, Vertos, and Vertiflex. The other Topic Editors declare no competing interests with regard to the Research Topic subject.
Keywords: Neuromodulation, Interventional Pain Medicine, Pain Medicine, Dorsal Column Stimulation, Peripheral Nerve Stimulation, Dorsal Root Ganglion Stimulation, deep brain stimulation (DBS), chronic pain, electrophysiology, cerebral localization, lesioning
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