Neuromodulation in chronic pain: clinical evidence and technological perspectives

Abstract

Background: Chronic pain is a highly complex pathophysiological condition, associated with central sensitization and alterations in nociceptive modulation, with a significant impact on functionality and quality of life, especially in patients refractory to drug treatment. In this scenario, neuromodulation stands out as a therapeutic strategy capable of directly modulating neuronal activity through electrical, magnetic, or chemical stimuli, acting on circuits involved in pain transmission. Techniques include invasive approaches, such as deep brain stimulation and intrathecal infusions, and non-invasive approaches, such as transcranial magnetic stimulation and biofeedback. Recent advances have allowed the development of more precise devices, systems with real-time feedback, and biomarker-based strategies, expanding its clinical applicability. Objective: To analyze, through an integrative review, the clinical efficacy of neuromodulation in chronic pain and its technological advances. Methods: A search was conducted in the PubMed/MEDLINE, Web of Science, and BVS databases, using DeCS and MeSH descriptors related to chronic pain, neuromodulation, and therapeutic technologies, combined with Boolean operators AND and OR. Original articles published between 2020 and 2025, in Portuguese, English, or Spanish, involving the adult population were included. Selection was carried out by screening titles and abstracts, followed by full reading of the texts. Data on study characteristics, type of technique employed, and main clinical outcomes were extracted Results: The results demonstrate that neuromodulation is associated with a significant reduction in pain intensity, with positive repercussions on functionality and quality of life, especially in patients with difficult-to-control chronic pain. Invasive techniques show greater effectiveness in refractory conditions, especially those of neuropathic etiology, by enabling direct modulation of central nociceptive pathways and individualized adjustment of stimulation parameters. In contrast, non-invasive techniques are effective in modulating cortical excitability and peripheral pain transmission, with a more favorable safety profile and greater feasibility for clinical application. It is also observed that systems with real-time feedback allow for dynamic adjustment of stimulation based on the neurophysiological response, while the incorporation of biomarkers contributes to patient stratification and therapeutic personalization. Furthermore, the integration of neuromodulation modalities with emerging digital technologies suggests a synergistic effect, with the potential to optimize clinical outcomes and therapeutic effectiveness. Conclusion: is concluded that neuromodulation is an effective strategy in the management of chronic pain, especially in refractory cases. Technological advances and therapeutic personalization reinforce its role in the medicine of the future, promoting greater precision and improved quality of life.