New Stories: Translating Findings From Nonpharmacological Interventions into Practice: Neuromodulation
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Description
Contributors
Neuromodulation techniques are widely and
long-establishedly used in the treatment of chronic pain. The classical
techniques include: transcutaneous electrical stimulation (TENS), electrical
stimulation of the dorsal columns of the spinal cord, epidural stimulation of
the motor cortex. More recently new non-invasive electrical (TENS) or magnetic
(rTMS) cortical stimulation, vagal stimulation, or occipital stimulation have
been developed.
The general principle underlying the use of
these different approaches is to act on the systems that modulate the
transmission of pain signals from the periphery to the brain. These treatments
are based directly on experimental works that analysed these mechanisms in
animals as early as the 1960s.
Pain modulation systems have been the subject
of a considerable amount of experimental works since the 1960s, starting with
the identification of the segmental modulatory controls organized in the spinal
cord, which formed the basis of the famous and classical "gate control"
theory. During the 1970s and 1980s, experimental studies lead to the discovery and
characterization of descending modulatory systems, originating, in particular, in
the brainstem, and which exert a powerful control (inhibitory or facilitatory)
on the activities of nociceptive neurons of the spinal dorsal horn. Other electrophysiological
studies showed the modulatory role of motor cortex stimulation in the early
1990s.
This is a very nice example of the success of
translational research insofar as the clinical applications of these
experimental discoveries have had an immediate impact in the clinic. It should
be remembered that TENS techniques and spinal cord stimulation were used in
humans less than 5 years after the publication of the experimental work that
led to the proposal of the "gate control" theory. Similarly, brain
stimulation techniques aimed at acting on the modulation systems organised at
the supraspinal level were also very rapid. The first epidural stimulations of
the motor cortex was performed as soon as the experimental results were
published. It is on the basis of these results that, only a few years later,
non-invasive stimulation techniques such as rTMS, which are currently
undergoing strong clinical development, were subsequently used. Interestingly,
new experimental works based on these clinical data are now investgating
further the mechanisms of action of these non invasive brain stimulation
techniques. Thus, this is an example of the bidirectional nature of
translational research.