Where is the evidence base to support neuromodulation?
The scientific community who are involved with neuromodulation have recognised the need to produce high quality evidence of clinical efficacy. Considering the difficulties in performing randomised controlled trials with surgical techniques much has been achieved, such as SCS for Angina pectoris, critical limb ischaemia, complex regional pain syndrome and neuropathic failed back surgery syndrome. Similar quality has been achieved with sacral nerve stimulation for faecal and urinary incontinence, intrathecal baclofen in spasticity, intrathecal opioids in cancer pain and vagal nerve stimulation in epilepsy, and cochlear implantations.
