Therapeutic time window of noninvasive brain stimulation for pain treatment: inhibition of maladaptive plasticity with early intervention

Neuromodulatory effects of noninvasive brain stimulation (NIBS) have been extensively studied in chronic disorders such as major depression, chronic pain and stroke. However, few studies have explored the use of these techniques in acute conditions. A possible use of NIBS in acute disorders is to prevent or reverse ongoing maladaptive plastic alterations, seemingly responsible for treatment refractoriness and detrimental behavioral changes. In this review, the authors discuss the potential role of NIBS in blocking maladaptive plasticity using the transition of acute to chronic pain in conditions such as postsurgical pain, central poststroke pain, pain after spinal cord injury and pain after traumatic brain injury as a model. The authors also present suggestions for clinical trial design using NIBS in the acute stage of illnesses.