Approaches to the Treatment of Chronic Pain

Recent advances in neuromodulation approaches have resulted in several promising applications for the treatment of various chronic pain disorders. This course will review several of the more popular applications, including transcranial direct current stimulation (tDCS), transcutaneous vagus nerve stimulation (tVNS), and transcranial magnetic stimulation (TMS). The neural mechanisms by which these neuromodulatory therapies access pain associated brain circuitries will also be reviewed, and neuroimaging evidence will demonstrate how these therapies might impact brain physiology. For instance, recent functional MRI (fMRI) research for applications of tVNS in migraine has demonstrated targeting of specific medullary nuclei and modulation of pontine raphe response to processing along the spinal trigeminal pathway in these patients. Finally, the side effect profile for different neuromodulatory approaches should be considered with respect to pharmacological approaches to chronic pain management. (Recorded at PAINWeek 2016)