Transcranial stimulation and the pain experience

Transcranial stimulation describes non-invasive approaches to modulate activity within the underlying cortex, providing methods to probe and treat pain. These approaches have informed the pathophysiological underpinnings of acute and chronic pain and have been used to modulate the perception of pain in healthy individuals and clinical populations. However, the therapeutic application of transcranial stimulation for pain remains largely investigational. This chapter provides an overview of the current state of the evidence for transcranial stimulation in pain, focusing on transcranial magnetic and transcranial electrical stimulation, as well as newer approaches such as transcutaneous vagus nerve stimulation and transcranial focused ultrasound. Adjunctive treatment approaches, where transcranial stimulation is combined with other forms of therapy, are also discussed. Throughout the chapter, limitations and future directions for the field are presented.