Neuromodulation is a therapy that blocks pain signals at the spinal cord before they reach the brain. This helps patients relieve their chronic pain and decrease or stop the use of pain medications, especially opioids. If you’re in chronic pain, the Interventional Pain Doctors team of orthopedic and spine pain management specialists will provide you with the right solution, specific for you.
For more than 50 years, neuromodulation has been used as a treatment for chronic pain. Innovation and scientific advancements since then have made it possible to customize this therapy to patients’ specific needs and has also made the therapy more successful. It is mainly used to decrease or eliminate pain caused by nerve damage from degenerative disc disease, post-shingles pain or injury or diabetic peripheral neuropathy. Increasingly, neuromodulation therapy is also being used by patients who experience persistent pain after spinal surgery. Other successful uses of neuromodulation is in treating complex regional pain syndrome, a chronic condition affecting one limb following an injury or surgery.
To determine if you’re a good candidate, the Interventional Pain Doctors team of spine and pain management specialists will meet with you, discuss treatment risks, benefits and alternatives. If you don’t want surgery or have tried and failed conservative measures, we may recommend neuromodulation for you. This is a two step process where you get to try the therapy before getting the final procedure. There are several types of neuromodulation systems available that might be effective in your pain relief.
Trial: During a trial, a temporary lead (thin wire) is placed using a needle into the epidural space and connected to an external device to see if neuromodulation works for you. The trial lasts between 3 - 10 days, during which time you and your doctor will assess the effectiveness of treatment. If you get significant relief of pain (50-100% reduction) and/or significant improvement in your function, and/or a 50% or greater reduction in narcotic pain medicine this is a successful trial, you are a good candidate for neurostimulation, and the temporary leads will be removed.
It is believed that electrical pulses prevent pain signals from being received by the brain. If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed.
Permanent: Permanent placement of a neuromodulation device would be scheduled if the trial is successful. During the permanent placement of the neuromodulation device, a small incision is made and the battery and the leads are placed under the skin, very similar to a pacemaker procedure. Stimulation does not work for everyone and if you don’t get relief during the trial you will not be offered the permanent implant as a therapy. It is the one area of medicine where you get to try the therapy and see if it is successful before having the permanent procedure.
We use the process of the trial to show who will get relief.
Reported risks of neuromodulation are rare, but include: bleeding, infection, nerve injury, headache. A small percentage of patients may experience: hardware failure, loss of effectiveness, allergic reaction to the device, stimulator removal, and biological complications such as increased pain, dural tear in the epidural space, and skin erosion. Sophisticated neuromodulation devices, doctor expertise, sterile operating conditions and image guidance keep complications to a minimum.
After Therapy: Spinal cord stimulation is an outpatient procedure. After surgery, you may feel a slight discomfort in the incision sites, which may last three to seven days. Your doctor will administer local anesthesia in the area near the implant site for pain relief. They will also prescribe pain medication and ask you to apply an ice compress to the area to keep the pain and swelling down.
Aftercare Tips: Rest for a few days after the procedure to promote safe healing. Gentle walks are fine; avoid intense activity and lifting heavy objects.
Keep incision sites clean and dry. Do not bathe for three days after the procedure. You can have a sponge bath. Your doctor will tell you when you can start showering again.
You will have a follow-up appointment two weeks after receiving the implant. Your doctor will check the incision site for infection and understand how well the stimulator is working for you. After you’ve healed completely and find pain relief, you can resume your normal activities.
