Cerebellar Non-Invasive Brain Stimulation: A Frontier in Chronic Pain Therapy

Abstract

Chronic pain poses a widespread and distressing challenge; it can be resistant to conventional therapies, often having significant side effects. Non-invasive brain stimulation (NIBS) techniques offer promising avenues for the safe and swift modulation of brain excitability. NIBS approaches for chronic pain management targeting the primary motor area have yielded variable outcomes. Recently, the cerebellum has emerged as a pivotal hub in human pain processing; however, the clinical application of cerebellar NIBS in chronic pain treatment remains limited. This review delineates the cerebellum's role in pain modulation, recent advancements in NIBS for cerebellar activity modulation, and novel biomarkers for assessing cerebellar function in humans. Despite notable progress in NIBS techniques and cerebellar activity assessment, studies targeting cerebellar NIBS for chronic pain treatment are limited in number. Nevertheless, positive outcomes in pain alleviation have been reported with cerebellar anodal transcranial direct current stimulation. Our review underscores the potential for further integration between cerebellar NIBS and non-invasive assessments of cerebellar function to advance chronic pain treatment strategies.

Keywords: brain stimulation; cerebellum; electroencephalography; evoked potentials; neurophysiology; pain; transcranial alternate current stimulation; transcranial direct current stimulation; transcranial magnetic stimulation.

Figure 1

Schematic representation of possible mechanisms of action of cerebellar NIBS in the con text of pain modulation (A) and list of NIBS techniques and biomarkers for cerebellar activity used that have been in previous studies or are of potential interest (B). See text for details. ACC: anterior cingulate cortex; I: insular cortex; S2: secondary somatosensory cortex.