Faculty Bibliography

BACKGROUND:Neuromodulation is a rapidly advancing field in pain medicine, providing targeted, reversible interventions for patients with chronic pain unresponsive to conventional therapies. Advances in waveform technology, device design, and stimulation strategies have shifted neuromodulation from a last-resort approach to a core element of multidisciplinary pain management. Despite its growing adoption, variability in training, terminology, and clinical implementation underscores the need for consensus-driven frameworks to ensure safety, efficacy, and uniformity across practice settings. OBJECTIVES/OBJECTIVE:This review aims to define current and emerging concepts in neuromodulation, summarize the supporting evidence, and offer clinicians an evidence-informed framework for individualized application in chronic pain management. STUDY DESIGN/METHODS:Narrative review. METHODS:We conducted a comprehensive synthesis of neuromodulation strategies spanning spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), peripheral nerve stimulation (PNS), motor cortex stimulation (MCS), deep brain stimulation (DBS), and targeted drug delivery (TDD). The review integrates data from published studies and reviews to cover emerging concepts, classifications, indications, technological advancements, device features, clinical applications, and practical guidance for patient-specific decision-making. RESULTS:Over the past decade, neuromodulation use has expanded significantly, driven by technological and mechanistic innovations. Peripheral nerve stimulation (PNS) has become increasingly precise for focal neuropathic pain, demonstrating efficacy in migraine, hemiplegic shoulder pain, persistent spinal pain syndrome, post-amputation neuropathic pain, trigeminal neuralgia, plexus injuries, and multifidus dysfunction. SCS remains a mainstay for widespread neuropathic pain, including CRPS, painful diabetic neuropathy, and post-surgical syndromes, with innovations such as 10-kHz high-frequency and burst stimulation offering paresthesia-free analgesia and improved patient satisfaction. DRGS provides targeted relief for localized neuropathic pain, including post-herniorrhaphy and post-thoracotomy syndromes, with more predictable outcomes. Neurophysiological refinements, including differential target multiplexed (DTM) stimulation and closed-loop systems with evoked compound action potential (ECAP) feedback, enable real-time spinal control and consistent analgesia. Multiphase and surround-inhibition paradigms further enhance segmental coverage, energy efficiency, and rapid analgesic onset. TDD has evolved into a precise adjunctive therapy, with programmable pumps delivering morphine, baclofen, and ziconotide safely, minimizing systemic exposure while allowing individualized dosing. Collectively, these innovations support precision-guided, personalized neuromodulation with durable efficacy and improved patient-centered outcomes across diverse chronic pain conditions. LIMITATIONS/CONCLUSIONS:Heterogeneity in published evidence and the lack of large-scale, head-to-head randomized trials for certain waveforms and technologies limit the conclusions of this review. CONCLUSIONS:Neuromodulation continues to advance at the intersection of neuroscience, bioengineering, and clinical practice. Harmonizing definitions, classifications, and education will guide future innovation and help ensure that neuromodulation fulfills its promise of safe, effective, and equitable patient care.

Voltage-gated sodium channels are integral for various physiologic processes including neurological signaling and cardiac contractility in humans. Classically a target to regulate cardiac arrhythmias, sodium channel inhibitors have held special interest as pharmacologic targets for pain management. However, the lack of receptor selectivity and specificity have resulted in various unwanted side effects and limited therapeutic ranges for nonspecific sodium channel blockers. Recently, suzetrigine, a voltage gated sodium channel subtype (NaV 1.8) selective inhibitor has been released and utilized for acute pain management with promising results. In this manuscript we highlight the physiology and pathology of voltage gated sodium channels along with current pharmacologic options in regards to its potential role for chronic pain management.

OBJECTIVE/UNASSIGNED:To examine how product popularity and pricing are associated with customer satisfaction across pain-relief device types on online e-commerce platforms. METHODS/UNASSIGNED:A cross-sectional study was conducted to analyze pain-relief products from Amazon and Best Buy. Data were collected via automated web scraping, verified, and categorized into 10 device types. Key variables including product names, prices, customer ratings, and review volumes were assessed in multivariable regression models. RESULTS/UNASSIGNED:A total of 378 distinct pain-relief products were analyzed. The median customer ratings for pain-relief devices varied significantly by type, ranging from 3.2 to 4.5 (p < 0.001). TENS units and cold/heat therapy packs achieved the highest median ratings of 4.5 (4.3-4.6). In contrast, hand/arm massagers received the lowest median rating of 3.2 (2.2-4.2). Pricing differences across device types were significant (p < 0.001), with neck stretchers being the least expensive (median: $29.99) and hand/arm massagers being the most expensive (median: $249.50). DISCUSSION/UNASSIGNED:Although price and the number of reviews were not significant predictors of customer ratings in multivariable regression models, significant interactions were observed between price and device type for hand/arm massagers (p < 0.001) and massage guns (p = 0.006). Additionally, significant interactions between the number of reviews and device type were observed for hand/arm massagers (p = 0.004). CONCLUSION/UNASSIGNED:Although pricing and review quantity were not significant predictors of satisfaction for most devices, they did interact with specific categories such as hand/arm massagers and massage guns. These findings indicate that customer satisfaction is driven more by device-specific characteristics than by price or review volume.

OBJECTIVE/UNASSIGNED:Remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) are growing digital health applications. The use of RPM, focusing on objective physiologic data, has been supported by evidence for managing chronic conditions. RTM, which collects subjective patient-reported data, is newer, but offers great potential in musculoskeletal (MSK) rehabilitation and chronic pain management that has already been recognized clinically and by reimbursement frameworks. However, in comparison with RPM, there is limited evidence directly assessing whether RTM contributes to improved clinical outcomes. This review compares the quality of current evidence for improved clinical outcomes from RTM in MSK and pain-related conditions with RPM in chronic disease management. METHODS/UNASSIGNED:A systematic search of PubMed, Scopus, and the Cochrane Library was conducted through March 2025 using keywords related to remote monitoring, digital health, and MSK conditions. Only reviews and meta-analyses were included for RPM, while both primary and review studies were considered for RTM, restricted to MSK or pain-related outcomes. Three reviewers independently screened and read all articles to reduce risk of bias. RESULTS/UNASSIGNED:22 studies met inclusion criteria (9 RPM, 13 RTM). RPM reviews consistently demonstrated clinical benefits, including reduced blood pressure, HbA1c, and hospitalizations. Across RTM studies, feasibility, patient satisfaction, and engagement were consistently high, although studies were heterogeneous, with some yielding improved pain and activity levels, while others found no difference relative to usual care. CONCLUSION/UNASSIGNED:RTM consistently demonstrates strong feasibility and patient engagement in MSK rehabilitation and chronic pain management, though evidence for clinical superiority compared to standard care remains limited. Future studies should emphasize larger randomized trials with standardized functional outcomes, therapy adherence, and integration into rehabilitation and pain management workflows.