Newly Published
Editorial  |   June 2020
Neuromodulation for Pain Treatment: Building a Foundation for Future Study
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine (E.S., S.P.C.), and the Departments of Neurology and Physical Medicine and Rehabilitation (S.P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland; and the Departments of Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland (S.P.C.).
  • This editorial accompanies the article on p. XXX.
    This editorial accompanies the article on p. XXX.×
  • Accepted for publication April 24, 2020.
    Accepted for publication April 24, 2020.×
  • Correspondence: Address correspondence to Dr. Cohen: scohen40@jhmi.edu
Article Information
Editorial / Central and Peripheral Nervous Systems / Pain Medicine
Editorial   |   June 2020
Neuromodulation for Pain Treatment: Building a Foundation for Future Study
Anesthesiology Newly Published on June 15, 2020. doi:https://doi.org/10.1097/ALN.0000000000003384
Anesthesiology Newly Published on June 15, 2020. doi:https://doi.org/10.1097/ALN.0000000000003384
Over the last 20 yr, the field of neuromodulation has undergone a surge of innovation in device design that includes miniaturization, enhanced durability, multicontact arrays, wireless systems, closed-loop modulation, new waveforms, and accessibility to new targets in the nervous system. Accompanying these technological leaps is an ever-increasing utilization to treat pain. Although increased utilization may be partly due to practical issues related to more favorable reimbursement and an increase in the number of physicians performing implants, enhanced effectiveness should be the underlying tenet for expanding indications.
Determining clinical outcomes for pain treatment in general is challenging, but the study of neuromodulation has been particularly plagued by concerns regarding bias, reproducibility, blinding, control group selection, and translatability of preclinical models.1–3  Preclinical animal models are the foundation for new discovery; however, their generalizability to patients relies on the validity of models to mimic human biology and measures of assessment that reflect pain and suffering, which are impossible to directly measure in noncommunicative animals. In this issue of Anesthesiology, Yu et al. describe their development of a rat model of dorsal root ganglion field stimulation to demonstrate analgesia for not only neuropathic pain but also nociceptive pain from knee osteoarthritis, and in animals without injury.4  These findings raise important questions regarding the use of animal models in the study of electrical stimulation for different types of pain, study design, and anatomical targets for selective stimulation.