Neuromodulation for People Living with Pain: Current Evidence and Future Directions

Abstract

Neuromodulation is a rapidly evolving field in pain medicine, offering a range of non-invasive and invasive interventions that target the nervous system to alleviate pain. This refresher course provides a comprehensive, evidence-informed overview of contemporary neuromodulation approaches for people living with pain, integrating mechanistic insights, clinical applications, and critical appraisal of the current evidence base.

The course will begin with an overview of non-invasive brain stimulation techniques, including transcranial magnetic and electrical stimulation, highlighting their supposed mechanisms of action, neurological effects, and potential future developments. It will then examine invasive neuromodulation approaches, such as spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation, and emerging technologies, with a focus on clinical indications, patient selection, and evolving stimulation paradigms.

A central theme of the course is the critical evaluation of evidence. Faculty will explore the strengths and limitations of the current neuromodulation literature, including challenges in trial design (e.g., blinding, placebo effects, and heterogeneity), interpretation of open-label versus sham-controlled studies, and the influence of industry involvement. Attendees will be guided in interpreting findings from systematic reviews, randomised controlled trials, and real-world data, with an emphasis on identifying bias and understanding uncertainty in evidence synthesis.

Finally, the course will address future directions in neuromodulation, including precision medicine approaches, closed-loop systems, and integration into multidisciplinary pain care pathways. By combining methodological rigor with clinical relevance, this course will equip participants with the knowledge and skills to critically engage with neuromodulation research and apply evidence-based approaches in both clinical and research settings.

Educational objectives:

By the end of this course, participants will be able to:

• Differentiate between major non-invasive and invasive neuromodulation techniques used in pain management, including their mechanisms of action and clinical indications.
• Appreciate clinical decision-making processes for neuromodulation therapies across different pain conditions.
• Critically appraise the current evidence base for neuromodulation interventions (spinal cord stimulation and non-invasive brain stimulation), with reference to key trial design challenges and methodological limitations.
• Interpret findings from systematic reviews and clinical trials in neuromodulation, identifying sources of bias, heterogeneity, and challenges in evidence synthesis.
• Discuss emerging technologies and future directions in neuromodulation.
• Apply knowledge of neuromodulation evidence to clinical or research contexts, including formulating relevant research questions or considering clinical pathways reviews.

Faculty list with each individual talk title

Prof Markus Ploner, TU Munich

Non-invasive neuromodulation of the brain: Current state and future directions.

Lecture content:

• Overview of non-invasive neuromodulation techniques
• The effects of neuromodulation techniques on pain
• Mechanisms of neuromodulation effects on pain
• Future directions

Dr Michael Ferraro, NeuRA, UNSW

A systematic overview of current spinal cord stimulation studies: Assessing the evidence base

Lecture content:

• Overview of the SCS evidence landscape
• What the evidence says about benefits and harms
• Challenges in clinical trials of spinal cord stimulation
• Open-label versus sham-controlled trials
• Conflicts of interest in SCS research

Dr Ganesan Baranidharan, Leeds Teaching Hospitals NHS Trust / University of Leeds

Invasive neuromodulation techniques: Current state of the art, clinical trial challenges, and future directions.

Lecture content:

• Overview of established invasive neuromodulation techniques for pain management, including spinal cord stimulation, dorsal root ganglion stimulation, Multifidus muscle stimulation and peripheral nerve stimulation. 
• Current clinical applications and technological advances, with emphasis on patient selection, stimulation paradigms, and outcome measures.
• Critical appraisal of the evidence base, highlighting key findings from randomised trials, registries, and real‑world data.
• Major clinical trial challenges, including issues of blinding, placebo effects, heterogeneity of patient populations, and long‑term outcome assessment.
• Future directions in invasive neuromodulation, focusing on precision medicine approaches, closed‑loop systems, improved trial design, and integration into multidisciplinary pain care.