Neuromodulation Spinal Cord Stimulation and Peripheral Nerve Stimulation

By Joseph Oppong, Jr, MD

Innovative Pain Solutions Center

. https://innovativepainmd.com/

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Neuromodulation Spinal Cord Stimulation and Peripheral Nerve Stimulation

Neuromodulation involves direct stimulation of the nervous system with electrical signals. It is used as a treatment for unmanageable chronic pain and/or movement disorders. There are a number of forms of neuromodulation. In this article we will discuss

Spinal Cord Stimulation where the nervous tissues on a specific portion of the spinal cord are electrically stimulated to block pain signals to the brain

Peripheral Nerve Stimulation where a specific nerve is targeted to relieve pain locally

Neuromodulation is indicated for patients with movement disorders and chronic pain that are not adequately controlled by drug therapy and who suffer from one of the following

Parkinson's disease

Essential tremor

Primary dystonia

Chronic intractable pain of trunk and limbs including

– Chronic back and leg pain associated with Failed Back Surgery Syndrome (FBSS)

– Complex Regional Pain Syndrome (CRPS)

– Peripheral vascular disease (PVD)

– Intractable angina pectoris (AP)

Spinal cord stimulation is used to treat chronic pain syndromes such as post-surgical failed back syndrome and complex regional pain syndromes. The procedure is often used to treat peripheral neuropathy, which can be caused by blood flow limitations to the lower extremities or diabetes. The spinal cord stimulation is only used on people who have failed standard medical treatments.

Spinal cord stimulation is an outpatient procedure. First, a temporary electrode is implanted in the epidural space over your spinal cord to see your response. If it works well, a permanent spinal cord stimulator is used. This device emits mild electrical pulses that stimulate the spinal cord directly. The device is programmed so that the amplitude, pulse width, and frequency best control your pain.

The permanent spinal cord stimulator operates on batteries that last for about 10 years.

Peripheral nerve simulators work much like spinal cord simulators, except that the mild electrical currents are sent directly to nerves outside of the spinal cord. Peripheral nerves run from your spinal cord to the limbs or organs in your body.

A neuropsychological examination is first conducted. Then, as with spinal cord stimulation, there is a trial run to test your response to temporary electrodes that are placed along the length of the offending peripheral nerve. If your pain does not subside significantly, the electrodes are removed. If it works, then permanent electrodes are placed at the nerve site and an internal battery-operated stimulator under the skin. These batteries last for several years and can be replaced easily. Once the stimulator is in place, the electrical pulse settings are customized to provide the highest level of pain relief.

Both procedures are typically performed under local anesthesia, on an outpatient basis.