Peripheral neuromodulation for pain.

The past decade (1999-2009) has witnessed a dramatic increase in the use of electrical stimulation to treat chronic, intractable pain. The implantation of electrodes in close proximity to peripheral nerves, known as peripheral nerve stimulation, has been enthusiastically adopted by neurosurgeons and interventional pain specialists. The most common conditions treated with this technique are headache and complex regional pain syndromes. The potential application of peripheral neuromodulation to relatively common and frequently disabling conditions such as migraine and lower back pain represents an exciting phase in the evolution of contemporary pain surgery. We review the available evidence relating to the use of peripheral nerve stimulation for the treatment of medically refractory, chronic non-cancer pain in a variety of clinical situations, highlight the absence of randomised controlled studies, and emphasise the need for scientifically sound research in this field.