When oral or parenteral drugs fail, the problem is what to do. In view of the continuing efforts aimed at neural reconstruction in the human brain and thus “physiologically” revert pain, and progress in neuromodulation and drug therapy, today there is only little room left for ablative procedures. Despite temporary initial benefit with several of these, destructive surgery at any level of the CNS has only a low long-term (>5 years) success rate, with a high incidence of recurrence and only few lucky patients totally relieved in the long term (Tasker 2001). Moreover, all techniques carry a serious risk of permanent, disabling complications, including new or worsening of pre-existent CP, as ablation only adds further damage.

The only true option is neuromodulation. This can be mainly achieved through electrical stimulation of the damaged nervous system or intrathecal pharmacologic infusion through implanted pumps.

ELECTRICAL

The analgesic effect of electrical stimulation has been known since Roman (and perhaps even earlier) times, when the shock from an electric fish was used to relieve gout pain and other pains, a custom that was not lost in the following centuries. The eighteenth century witnessed a resurgence of this technique, despite strong opposition.