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What is neuromodulation?
Neuromodulation through a spinal cord stimulator (SCS) is an advanced pain relief technology designed to manage chronic pain by altering how the nervous system processes pain signals. This therapy delivers mild electrical impulses directly to the spinal cord or specific peripheral nerves. These impulses interfere with the pain signals sent to the brain, effectively reducing or altering the pain sensation without the need for heavy reliance on medications.
The system comprises a small, pacemaker-like device (the generator) implanted under the skin, usually near the buttocks or abdomen. This generator is connected to thin wires (leads) positioned near specific nerves or in the epidural space of the spinal cord. Patients can control the intensity of these impulses, often via a remote control, to increase or decrease the strength of the signals based on their pain levels and activity.
How does neuromodulation work?
Neuromodulation through a spinal cord stimulator sends mild electrical impulses directly to the spinal cord or targeted peripheral nerves to manage chronic pain. These impulses are generated by a small, pacemaker-like device implanted under the skin. The device is connected to thin wires called leads, positioned either around specific nerves or in the epidural space near the spinal cord.
The basic principle is similar to listening to music through headphones to drown out background noise. In this case, the “music” is the electrical impulses that interfere with the pain signals sent to the brain. By interrupting or altering these signals before they reach the brain, the pain sensation is diminished or changed, providing relief to the patient.
Here’s a step-by-step breakdown of how neuromodulation works:
- Implantation: the system consists of two main components: the leads and the generator. The leads are placed first, either during a trial period to assess effectiveness or permanently if a trial has already been successful. The generator, which produces the impulses, is implanted under the skin through a minor surgical procedure.
- Delivery of electrical impulses: once implanted, the device sends out low-voltage electrical impulses through the leads to the targeted nerves or spinal cord. This action modulates pain signals, essentially preventing them from being recognised as pain by the brain.
- Patient control: patients have some degree of control over the intensity of these impulses, usually through a remote control. This allows for real-time adjustments based on activity levels, time of day, or specific pain requirements. Different stimulators offer various modes of stimulation, such as constant low-level pulses or bursts of pulses, depending on what provides the most relief.
- Customisation and adjustment: your pain specialist can program and reprogram the system to optimise pain relief. This includes adjusting the strength of the impulses and the areas targeted. Some devices can also store preset programmes for specific activities or pain levels.
This therapy is especially suited for chronic pain conditions that are unresponsive to more conventional treatments. It is a reversible, minimally invasive option that offers an alternative to long-term medication use, aiming to improve the quality of life for those with persistent pain.
Benefits of neuromodulation
- Targeted pain relief
- Reduced medication dependency
- Adjustable and customisable:
- Reversible
- Effective and sustained pain relief
What conditions can neuromodulation treat?
Neuromodulation, particularly through spinal cord stimulators, treats a variety of chronic pain conditions by modulating the nervous system’s response to pain.
- Failed back surgery syndrome: for patients who have undergone back surgery but continue to experience pain, spinal cord stimulators offer a way to manage this persistent discomfort.
- Complex regional pain syndrome (CRPS): complex regional pain syndrome is characterised by severe, chronic pain often affecting the arms or legs. Neuromodulation can be particularly effective in managing the pain associated with this condition.
- Neuropathic pain: this type of pain arises from damaged nerves and can manifest as sharp, shooting, or burning sensations. Neuromodulation can target the nerves involved, providing relief from conditions like diabetic neuropathy and postherpetic neuralgia (pain following shingles).
- Chronic pain after amputation: phantom limb pain and stump pain are common after amputation. Neuromudoulation can help alleviate these painful sensations by targeting the nerve pathways.
- Spinal cord injuries: for individuals with spinal cord injuries, neuromodulation can help manage pain that is often a result of the injury, including both neuropathic and musculoskeletal pain.
- Chronic knee pain: even after knee surgery or other treatments, some patients continue to experience chronic knee pain. Neuromodulation can offer an alternative pain management strategy.
What results can I expect after neuromodulation?
After undergoing neuromodulation with a spinal cord stimulator, patients can expect a range of outcomes primarily aimed at managing chronic pain. The results vary from person to person, but here’s a general overview of what you might expect:
- Pain relief: the most significant and desired outcome is reducing pain.
- Reduced medication dependency: with effective pain management through neuromodulation, some patients find they can reduce or even eliminate their reliance on oral pain medications, including opioids. This reduction can lead to fewer side effects and a lower risk of dependency.
- Improved quality of life: as pain decreases, your overall quality of life can significantly improve. This improvement might manifest as increased mobility, better sleep, more engagement in activities of daily living, and enhanced mood.
- Customisation to individual needs: neuromodulation allows for adjustments to the electrical impulses based on your specific pain needs and lifestyle. This flexibility means that the therapy can evolve with you, offering tailored pain management over time.
- Management of specific conditions: neuromodulation is particularly effective in managing symptoms and improving patient outcomes for conditions like failed back surgery syndrome, complex regional pain syndrome, and neuropathic pain.
- Activity level changes: some patients find that with reduced pain, they can gradually increase their activity levels.
How many neuromodulation sessions are needed?
The process involves two key phases: a trial period to assess efficacy and a subsequent surgery for permanent implantation if the trial proves successful.
Frequently Asked Questions
A neuromodulator refers to the broader technology or substance that modulates nerve activity. In contrast, a neurostimulator specifically refers to a device that stimulates nerves or the spinal cord through electrical impulses.
The device can remain implanted for several years, depending on factors like the type of stimulator and the patient’s specific condition. Regular follow-ups are necessary to ensure its effectiveness and safety.
Neuromodulation is the overarching principle or technology, while a spinal cord stimulator is a specific device used for neuromodulation, particularly for pain management.
Patients are generally advised to avoid activities that could dislodge or damage the device, such as heavy lifting or high-impact sports, immediately after surgery. Long-term restrictions may vary based on individual cases and the advice of healthcare providers.
Total Pain Specialist