Pain is an unpleasant sensation caused by illness or injury. Pain can have a negative impact on a person's quality of life. Chronic pain is the pain that is constant and persists for long periods of time. The treatment options for chronic pain include medications, surgical interventions, physical therapy, and psychotherapy. Neuromodulation is considered a method of treatment for chronic pain relief and involves the alteration of nerve activity for relief of pain either through electrical stimulation or medication administered directly to a target site by means of implanted devices.
Indications
Neuromodulation can be used to treat patients with various diseases or symptoms, including headaches, chronic back pain, and other painful disorders.
Types
The two main types of neuromodulation techniques include:
- Neurostimulation
- Implanted drug pumps
Neurostimulation
Neurostimulation provides pain relief by blocking the transmission of pain signals before they reach the brain. It involves delivering low-level electrical impulses to the brain, spinal cord, or nerves. This stimulation blocks the sensation of pain and replaces the painful sensations with a tingling sensation. It is a treatment option for patients with chronic pain in their back or limbs who had conservative treatments and found no relief. The system can be turned on and off by remote control or adjusted as required to provide optimal pain relief.
There are two types of neurostimulation techniques :
- Spinal cord stimulation: Spinal cord stimulation delivers an electrical current to the spinal cord for the management of chronic back pain. Your physician places a stimulation device under your skin in either the abdominal or buttock area. Leads from the device are routed to your spinal cord. At the end of the leads are the electrodes that deliver electrical signals to the spinal cord. The electrical current interrupts the pain signal from reaching your brain. As a result, instead of pain, you may now feel a tingling sensation in the area of your back problem.
- Peripheral nerve stimulation: Peripheral nerve stimulation involves the placement of a stimulating electrode in close proximity to peripheral nerves in order to control pain. Very similar to spinal cord stimulation, peripheral nerve stimulation works by introducing an electrical current to the source of chronic pain. Peripheral nerve stimulation is used in the treatment of a variety of disorders.
Before the placement of a permanent stimulation device, you must undergo a trial to determine if the treatment decreases your level of pain.
Implanted Drug Pumps
An implantable drug delivery system involves implanting a small pump that delivers pain medication directly to the spinal cord where pain signals travel. As the medication is delivered directly to the targeted area, smaller doses of medication are required to provide relief. An implantable drug delivery system is considered a last option when other methods of pain control are ineffective. Implanted drug pumps are effective in treating cancer pain, severe back pain, neuropathic pain, muscle spasticity, and post-operative pain.
The drug pump is surgically implanted beneath the skin of your abdomen. Then the pump is connected to the catheter placed in the intrathecal space (inside the layers of the spinal cord itself) or epidural space (just outside the spinal cord). The catheter carries pain medication from the pump to the spinal cord and nerves. Before the placement of a permanent pump, you must undergo a trial to determine if the treatment decreases your level of pain.
Risks
Risks of spinal cord stimulation may include:
- Infection
- Pain at the site of incision
- Cerebrospinal fluid leakage
- Lead breakage
- Movement of the lead within the epidural space
- Battery failure
Risks associated with a drug pump implant are minimal. However, risks may be caused by problems with the catheter or the pump, requiring a second surgical procedure to repair. The risks associated with implantable drug pumps include:
- Inflammatory granuloma (an infection at the tip of the catheter)
- The catheter can kink up or disconnect
- Spinal fluid leak
- Headache
- Side effects from medications
