Neurostimulation in the treatment of chronic pain

Different types of neurostimulation are proposed essentially in cases of ch ronic neuropathic pain, non controlled by anticonvulsivants and antidepress ants. The aim is usually to activate a failing inhibitory system, involved in the transmission and the modulation of the nociceptive stimulus. The sit e of stimulation (transcutaneous, spinal cord, thalamic) is choosen accordi ng to the severity of pain and especially the degree of lemniscal dysfuncti on evaluated by clinical and electrophysiological data. Transcutaneous elec trical stimulation and spinal cord stimulation are efficient for neurogenic pain secondary to partial deafferentation. When dysfunction or lesion exte nd to the pre-ganlionic portion, it's preferable to propose stereotactic th alamic stimulation or central gyrus stimulation. The analgesic effect conce rns permanent burning pain in the context of sensitive deafferentation : af ter distal nervous lesions, radicular, plexular or spinal lesions or after stroke with ischemic lesions along the nociceptive pathways. These differen t methods must only be proposed if there is a frequent clinical and technic al monitoring.