Neuromodulation And Spinal Cord Stimulation
Neuromodulation is the alteration of nerve activity by delivering electrical impulses (or pharmaceutical agents) directly to a target area. Neurostimulation is the use of electrical impulses to block or restore nervous system function and sensation.
Neurostimulation treatment reduces nerve activity through the delivery of electrical stimulation to targeted sites of the body.
The various form of neuromostimulation used for pain control include:
- Occipital nerve stimulation (ONS)
- Peripheral nerve stimulation (PNS)
- Sacral nerve stimulation (SNS)
- Spinal cord stimulation (SCS)
- Transcutaneous electrical nerve stimulation (TENS)
Spinal cord stimulation (SCS)
Spinal cord stimulation therapy is a revolutionary procedure that works by delivering a mild electrical impulse to the spinal cord to block pain signals from traveling up to the brain. It is a treatment generally reserved for severe intractable neuropathic pain.
The various form of SCS include
- Dorsal Root Ganglion (DRG) stimulation
- High frequency stimulation
- Burst Stimulation
- High Density Stimulation
Patients should be considered for neurostimulation if they have ongoing moderate to high intensity persistent neuropathic pain and if more conservative strategies have been comprehensively trialed and failed. This is called refractory neuropathic pain.
Specific indications for consideration for neurostimulation include:
- Complex regional pain syndrome (CRPS).
- Failed Back Surgery Syndrome (FBSS).
- Postoperative nerve pain condition
- Peripheral neuropathic pain
- Pelvic pain
- Intractable headache
Following a successful trial period, small electrodes are placed near the spinal cord in the epidural space. The electrodes are connected to a small battery that device delivers low-level electrical impulses that interfere with the perception of pain as it travels up the spine or any other nerve that is targeted.
What should I expect after the procedure?
If the procedure is successful, you may feel that your pain may be gone or quite less. You will experience a fairly constant sensation of stimulation. You may have soreness due to the needles used for a day or two. Generally, the procedure gives a reduction in the amount of pain and may decrease the amount of medications needed.
What should I do after the procedure?
This procedure is normally a day-procedure. Some patients may be kept overnight for observation. You should have a ride home. We advise patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you.
How long will the generators last?
The implanted generators are rechargeable and the charging interval depends on the amount of power required by you to feel comfortable. Recharge intervals are typically every 2-4 weeks. The generator has a 5-year guarantee but is expected to last much longer.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. Please discuss your concerns with your physician.
Who should not have this procedure?
The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (e.G. Coumadin, injectable heparin), or if you have an active infection going on. With blood thinners like coumadin, your doctor may advise you to stop this for 4-7 days beforehand or take “bridge therapy” with lovenox prior to the procedures. Anti-platelet drugs like plavix may have to be stopped for 5-10 days prior to the procedure.