Challenges for the 21st century: The future of electrical neuromodulation

Abstract

After a checkered past, the modern era of therapeutic neuromodulation began in the 1960s, since when many targets and applications have been developed. Some have come and gone. To compete successfully for limited resources, good-quality evidence of efficacy is increasingly demanded. This was previously lacking, as was a full appreciation of the implications of neuromodulation being a long-term treatment for chronic conditions. Its future will involve a complex interaction of improved understanding of the indications and mechanisms of action, exciting new indications, more mature assessment of outcomes, socioeconomic considerations, and fundamental technological developments. A shift away from a medication-dominated mindset should help physical treatments like neuromodulation to fulfill their enormous potential in future years. Earlier application may even modify the course of some conditions. © 2006 American Academy of Pain Medicine.