The Vault

Neuromodulation

Spinal Cord Stimulator/Peripheral Nerve Stimulator.

Neuromodulation is an advanced pain management technique used for intractable neuropathic pain. Conditions that can be treated with this include diabetic neuropathy, chronic radiculopathy, failed back surgery syndrome, reflex sympathetic dystrophy, and phantom limb pain to name a few.

It works by what is known as the “Gate Theory”. Special leads are placed in the epidural space and it is attached to a generator. Low voltage impulses are generated and transmitted superficially in an area of the spinal cord called the dorsal column. The patient now feels a tingling sensation instead of pain, and the electrical stimulation is acting to “close the gate” such that pain signals coming from below can’t reach the brain since the stimulator is occupying the pain tract. Another analogy would be a car trying to enter the freeway in a traffic jam. You (the pain signal) can’t get on the freeway because of the continual stream of cars passing by (the stimulator signal).

Since this is a permanent implant patients must undergo a trial to be sure that this therapy is right for you. During the trial, an IV is placed and the stimulator leads are advanced under live fluoroscopy to the appropriate level in the spinal cord. The leads are attached and you are asked if you feel the stimulation and if it’s covering the area of your pain. Adjustments are made to the generator and lead position until proper coverage is achieved. It is firmly taped and the procedure is complete.

The manufacturers representative will be in contact with you for five days after the procedure. After that the leads are pulled. If you had an excellent result you may be a candidate for permanent implant.

The permanent implant is the same as the trial except this time a small pocket is made under the skin, usually over the right or left hip. A battery is placed, the leads are tunneled under the skin, and the system is connected and proper functioning is tested. The small incision sites are closed and the patient is discharged the same day.

While this is an invasive procedure it has proven to be one of the most effective treatments for intractable neuropathic conditions. It can truly change the lives of patients living with these debilitating conditions.