Table 2.

Neuromodulatory chronic pain treatments: advantages and disadvantages

Treatment	Advantages	Disadvantages
Hypnosis	Moderate evidence supports short-term and long-term efficacy Encourages self-management and self-efficacy Few (if any) negative side effects Numerous beneficial side effects (for example, increased global well-being) Evidence supports effects on most neurophysiological processes involved in pain processing—supports potential benefits for a wide variety of pain problems	Outcome is variable: not everyone benefits Treatment requires patient involvement and motivation
Meditation	Preliminary evidence is promising Encourages self-management and self-efficacy Few (if any) negative side effects Reported beneficial side effects include increased well-being Preliminary evidence supports effects on brain structures involved in attention, emotional processing and pain	Evidence for efficacy not yet well-established Treatment requires patient involvement and motivation fMRI and EEG studies examining the neural correlates of meditation training among novices with chronic pain is lacking
Noninvasive brain stimulation (repetitive transcranial magnetic stimulation and transcranial direct current stimulation)	Preliminary evidence for short-term effects is promising Treatment requires minimal patient effort	Requires equipment Must be provided in the clinic (home practice not yet possible) Passive treatment (does not encourage self-efficacy) Evidence for long-term benefits is lacking; preliminary evidence suggests that benefits may be temporary Associated with minor transitory side effects (for example, fatigue, scalp irritation, dizziness) Mechanisms not yet understood
Neurofeedback (EEG and real-time functional MRI biofeedback)	Preliminary evidence for short-term benefits is promising Encourages self-management and self-efficacy	Requires equipment Effects appear to be weak Evidence for long-term benefits is lacking Mechanisms not yet understood Treatment requires patient involvement and motivation