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Neuroaugmentation
Interest in endogenous pain control systems as a therapeutic target began over 20 years ago in the context of the contemporaneous discoveries of the positive reinforcing quality of electric self-stimulation of the brain in animals and humans. Profound analgesia without drugs was reported in laboratory animals during electrical stimulation of the brain stem.391; 514 These effects appear to depend on the body's own opioids, endorphins. Since then, electrical stimulation for pain control has been directed at deep brain structures such as the periaqueductal and periventricular grey areas,328; 517 the limbic system,182 and other more superficial sites such as the pituitary gland.515 Evaluation of the efficacy of electrical stimulation ("neuroaugmentation") of deep brain structures for pain relief, as for many other modalities, is difficult because of scanty descriptions of patients' diagnoses and limited pain assessment and followup, as well as the relatively few patients treated in this fashion compared with much larger numbers treated, e.g., with pharmacotherapy. Nonetheless, the few descriptive, uncontrolled published studies report partial or complete pain relief in 27 to 76 percent of patients treated by neuroaugmentation.320; 327; 517 Published results of spinal cord stimulation for pain relief are less encouraging. Meglio and others321 reported, in a series of 109 patients treated for pain relief by means of spinal cord stimulation, that none of the 11 who had pain derived any clinical benefit, in contrast to favorable responses observed in patients with vasculopathic pain or postherpetic neuralgia. Similarly, others 353; 191; 294 have found spinal cord stimulation useful to treat chronic pain if not due to malignancy and only anecdotal observations support the success of this modality in patients with pain.333; 352; 386
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