Neuromodulation Q&A

Neuromodulation can help those suffering from chronic pain by significantly decreasing pain levels and improving their quality of life. Additionally, it may also decrease the use of chronic opioid and non-opioid pain medications. While it is not a “cure all,” neuromodulation is a powerful tool in our pain management tool box that can provide meaningful pain relief and improved function. Recent high-level studies (randomized controlled trials) show greater than 50% pain relief in over 80% of patients treated with this modality. The decision of which type of therapy is best for you is a nuanced process and requires joint decision making between you and the medical team.

What is it?

Therapeutic neuromodulation is the alteration of nerve activity through targeted delivery of an electrical stimulation to specific neurological sites in the body. Similar to how a cardiac pacemaker corrects abnormal heartbeats, neuromodulation therapies help to curb abnormal function of the pain pathways within the nervous system.

Can Neuromodulation Help You?

The treatment can relieve a variety of painful conditions, including:

• Chronic regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy (RSD) or causalgia
  
• Post-laminectomy pain syndrome, commonly known as “failed back syndrome”
  
• Chronic post-operative pain (after knee replacement, hip replacement, shoulder replacement and foot/ankle surgery)
  
• Chronic neuropathic pain, such as nerve pain, sciatica, diabetic nerve pain
  
• Chronic pelvic and testicular pain
  

How does it work?

One of the most common examples of neuromodulation is the use of spinal cord stimulation (SCS) for chronic pain management. SCS consists of a very thin lead (or wire) that is placed in the space just outside the spinal cord (known as the epidural space). The lead is attached to a small generator device that is implanted under the skin and subcutaneous layer in the back or buttock. The device will deliver frequent, low-voltage electrical impulses to the spine, with subsequent modulation of the pain signals in transit to the brain.

Another form of neuromodulation is the intrathecal pump, which is a device designed to deliver a desired medication directly into the spinal fluid surrounding the spinal cord. This technique allows a drug to be administered in much smaller doses, because it does not have to be metabolized through other body systems before reaching the target area. Smaller doses — in the range of 1/300 of an oral dose — can mean fewer side effects, increased patient comfort, and improved quality of life. The device consists of a small plastic tube called a catheter, which is placed in the intrathecal space of the spine and is connected to the pump; a space inside the pump called the reservoir holds the medication. This could be a pain medication, or a muscle relaxant to help relieve muscle spasticity in certain neurological disorders like cerebral palsy and multiple sclerosis.

Neurostimulation works by altering pain signals as they travel to the brain. It is a pain management therapy that delivers electrical stimulation to the spinal cord, dorsal root ganglion (a cluster of nerve cells in a dorsal root of in the spinal cord) and peripheral nerves. Using an implantable device, or neurostimulator, this treatment aims to reduce the user's perception and experience of certain types of pain inside the body.

Dorsal root ganglion (DRG) therapy helps users manage difficult-to-treat chronic pain limited to the lower extremities in patients with Complex Regional Pain Syndrome (CRPS). It can provide profound relief to those suffering from pain following hernia, knee replacement, and amputation surgeries.

Spinal cord stimulation (SCS) has been used for more than 50 years. It helps control chronic pain in the arms, legs and back resulting from failed back surgery or nerve damage. With SCS, a small, implanted device uses electrical stimulation to change pain signals and pain perception in your body.

Peripheral Nerve stimulation is a great advance in the field of neuromodulation. This allows us to target nerves of a specific body part, for example shoulder and knee to treat focal pain. A small lead placed along a nerve under X ray or ultrasound guidance with less than a half inch incision could stimulate the nerve directly and block painful signals being transmitted by that nerve. A very good example is chronic intractable shoulder pain after shoulder surgery can be treated by stimulating the suprascapular nerve. Just like other forms of neuromodulation, a trial is done first to determine effectiveness before performing the minimally invasive implant.