Most of us experience common tension headaches from time to time. They frequently are caused by stress. Rest, ice packs or a long, hot shower may be all you need to gain relief.

Some of us, however, suffer with far more persistent and chronic migraines and other headache syndromes. This group includes roughly 36 million Americans, including up to 18% of women and 8% of men. The American Migraine Foundation estimates that one in four American households has at least one member who suffers with migraines.

Migraines are much more than just a bad headache. Migraines can cause severe throbbing pain on one side of your head. They are often accompanied by nausea, vomiting, and extreme sensitivity to light, sounds and smells.

Migraine pain can be felt in the face, where it may be mistaken for sinus headache — or in the neck, where it may be mistaken for arthritis or muscle spasm. Medications can help prevent or relieve some migraines and make them less painful. However at least 5 to 10 percent of sufferers do not find relief from medications. And others experience issues with medication side-affects.

Woman suffering from chronic migraine headache.
Roughly 36 million Americans suffer persistent and chronic migraine headaches.

The Potential for Neurostimulation Relief

New options are currently being evaluated when chronic migraines don’t respond to medications and conventional treatments. These procedures involve nerve stimulation devices that target key nerves that may be involved with migraines:

  • Occipital Nerves: These are a group of nerves that arise from the C2 and C3 vertebrae at the top of the cervical spine and provide most of the feeling to the back of your head.
  • Supraorbital Nerve: This nerve supplies sensory functions to the upper eyelid, forehead, and scalp.
  • Trigeminal Nerve: This nerve is the part of your nervous system responsible for sending pain, touch and temperature sensations from your face to your brain.

The technology behind these innovative treatments date back to 1967. In fact, you may have heard of spinal cord stimulation (SCS), which a widely used neurostimulation therapy for pain management in other parts of the body. In this case for migraines, the same class of devices are specifically designed to deliver small electrical impulses to the occipital, supraorbital or trigeminal nerves.

How Does It Work?

What does this kind neurostimulation therapy involve? It uses small devices about the size of a silver dollar that produce mild electrical signals. Those signals are carried by thin leads to deliver electric pulses to the targeted nerves. A hand-held remote control operates the system to disrupt pain signals caused by migraine headaches and provide pain relief to sufferers.

The process doesn’t eliminate the cause of the pain, but instead, interrupts the transmission of pain signals so that the pain isn’t perceived by the brain.

How Effective Is the Treatment?

We should make clear that neurostimulation treatments for migraine relief are still at the medical trial stage, and investigational evaluations have been going on for the last 12 years. These small, preliminary studies investigating the use of neurostimulation as a treatment for chronic migraines appear to be showing some improvement in pain management. However, additional well-designed studies with larger populations and longer follow-up periods are needed before conclusions regarding the safety and efficacy of these techniques can be made.

The bottom line? There is evidence that this kind of nerve stimulation may be effective in treating chronic headache disorders. But more studies will be required before this therapy can be considered for routine use.

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Severe pain can affect all aspects of your life across social interactions, work, and leisure activities. When this happens, it’s time to see your doctor and consider what options are available to get back to a more normal way of living.

The origins of your pain may be in the low back, shoulder, or knee. Or it may be post-amputation or chronic or acute post-operative pain. Many patients don’t want to take opioids as a solution, even on a short-term basis. For appropriate cases, the answer may be a temporary Peripheral Nerve Stimulation (PNS) system.

An alternative that fits these criteria is the SPRINT PNS system. It does not require permanent implantation and is designed as a 60-day treatment to provide sustained pain relief.

What Is a Peripheral Nerve?

Your body’s nervous system is made up of your brain, spinal cord, and peripheral nerves. Peripheral nerves are the nerves that extend beyond your brain and spinal cord to your organs and extremities—all the way to your fingertips and toes.

Pain signals travel along these peripheral nerves to your brain.

How Does the SPRINT Peripheral Nerve Stimulation Work?

Neurostimulation works by delivering mild electrical signals that disrupt nerve pain signals before they reach your brain. In this way, you can achieve pain relief without the need for medication.

The SPRINT PNS system uses a small pulse generator that sends gentle pulses through very thin, fishing line-sized micro-leads to stimulate the nerve causing your pain. This pulse generator is located outside your body and is not implanted, as is the case for most other systems.

A simple handheld remote communicates with the pulse generator and allows you to easily control the level of pain-relieving stimulation that you need.

After the treatment period had ended, and the micro-lead (or leads) has been removed, the majority of patients continue to experience sustained relief.

The Procedure

During a minor outpatient procedure, your doctor will implant a thin micro-lead directly over the specific nerve or nerves causing your pain. Depending on the location of the nerve, either fluoroscopic (x-ray) or ultrasound guidance will be used to steer the lead to the correct location.

You can then expect to go about your normal activities when using the SPRINT system. When you take a shower, you’ll disconnect the SPRINT pulse generator – and you’ll avoid bathing and swimming during the treatment period.

The SPRINT system then is left in place for up to 60-days, after which your doctor will remove the micro-lead.

SPRINT PNS after procedure completion
SPRINT PNS system after procedure completion, with lead covered by a waterproof bandage and the pulse generator located externally.

Clinical Results to Date

Clinical studies have shown promising outcomes to date for the SPRINT PNS system. 75% of patients have reported significant and sustained pain relief.

The procedure is a good option for patients with low back pain, shoulder pain, knee pain, arthritic joints or discs, post-amputation pain, and post-operative pain. It is also a good option when a radiofrequency neurotomy isn’t considered a viable therapy – or when it has been tried but hasn’t been effective. It is appropriate when other neurostimulation treatments aren’t.

The SPRINT PNS system is a treatment that doesn’t involve medications, is fully adjustable, and can potentially offer more complete pain relief than other similar therapies. It is a safe procedure with low risks.

While appropriate patient selection is key, SPRINT peripheral nerve stimulation is an option to consider for acute and chronic pain where more conservative therapies have been exhausted.

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Jeffery Rowe, MD, is a physical medicine and rehabilitation physician, also known as a physiatrist, with a subspecialty in pain medicine. He practices at Main Line Spine and specializes in minimally invasive interventional spine surgeries.

In this Q&A, Dr. Rowe shares how he helps patients with new technologies and advanced treatment options to relieve chronic pain of the spine, including the low back and neck.

You practice a unique subspecialty. Could you tell us more about it?

When you have chronic pain, there are two ends of the spectrum where you can seek treatment.

At one end of the spectrum are physiatrists who utilize non-surgical and minimally invasive approaches and procedures to treat your pain. These approaches might range from exercise to physical therapy, medication management, and injections such as epidural steroid injectionsfacet blocks, and SI joint injections. Anesthesiologists who have had a spine fellowship also traditionally use these approaches.

At the other end of the spectrum are orthopedic and neurologic surgeons. They focus on much more major surgical procedures to address spine pain issues. These procedures include lumbar and cervical fusions and decompressive laminectomies to relieve pressure on the spinal nerve roots.

Many new treatments fall in the gap between these two extremes. These are minimally invasive surgical procedures to relieve pain, appropriate when conservative treatment options haven’t provided long-term benefits. These procedures offer patients options that are far less severe surgically than those where orthopedists and neurosurgeons traditionally focus.

My surgical subspecialty is providing patients with pain relief options in this treatment gap.

What kind of treatments and procedures are we talking about in this gap?

One area in this gap includes neuromodulation devices that work by interrupting pain signals before they reach your brain. These include traditional Spinal Cord Stimulators (SCS)Dorsal Root Ganglion (DRG) stimulators, and Peripheral Nerve Stimulators (PNS).

Neuromodulation technologies have improved by leaps and bounds over the past five years, and they now incorporate improved batteries and Bluetooth technologies for programming.

Another minimally invasive treatment option is an interspinous spacer device, which can provide relief from lumbar spinal stenosis. This procedure can be an alternative to surgical decompression, such as a laminectomy.

I began to adopt these procedures four years ago when they officially became commercially available. Given that I was one of the early adopters of this treatment option, I now regularly teach other physicians and surgeons on the proper usage of this decompressive technology.

I also perform a minimally invasive SI joint fusion procedure. This procedure is often appropriate when SI joint injections fail to provide long term improvement.

In the past, SI joint fusion surgery involved a lateral approach with significant muscle disruption, requiring a lengthy recovery period. Now we use a posterior approach with a small incision to provide SI joint stabilization and fusion. This new alternative causes minimal tissue disruption and has a very short recovery period.

Beyond those, there are several other procedures that I’m currently using to provide additional minimally invasive treatment options, as well as others emerging on the horizon.

How did you end up with this specialty focus?

I have a surgical background from the start of my medical career. I completed two years of general surgery and then worked at a burn surgery center for eight years. These experiences provided me with an extensive foundation in handling complex surgical conditions.

I also completed a physical medicine and rehabilitation residency at the University of Pennsylvania Hospital and a spine fellowship. From that point, I began specializing in providing patients with access to technologies and treatments in the gap that weren’t previously available.

The sum of this training and experience enables me to consider, with a surgical perspective, how best to use these advanced procedures.

Dr. Jeffery Rowe teaching the spinal cord stimulation procedure.

What kind of patients do you see? When is it appropriate for a patient to consult with you?

I see a broad range of patients. Some have only recently experienced an onset of pain, and others have been suffering from pain for years.

I pride myself in offering patients treatments when they have been told they exhausted all available pain treatment options. These previous failed attempts may have included epidural steroid injections, facet blocks, SI joint injections, rhizotomies, and radiofrequency nerve ablations.

For example, let’s say a patient has multi-level degenerative disc disease and they’ve had multiple injections but still have ongoing symptoms. The injections may have worked well, but the effectiveness wore off over time.

This hypothetical patient is now at a point where they need a longer-term solution with a more permanent treatment option. Neurostimulation or an interspinous spacer device may be an appropriate option for them.

My initial consultation is extensive as I tease through the issues each patient has been dealing with. I need to hear their full backstory, including how long they have been managing their condition and what they’ve done previously to attempt to alleviate their pain. I also review their diagnostic studies, including any MRIs or CT scans.

This thorough evaluation allows the patient and me to review the treatment options which are best suited for their condition. It also enables me to recommend a long-term treatment plan using one or more of the new technologies that sit in the gap.

Nationally, neuromodulation therapies don’t always work effectively for some patients. Why is it that you seem to get successful results with your patients?

Our ongoing successes build from a variety of factors. Patient selection is key to having a successful outcome. I take great care where I place the leads and reinforce that with strict testing protocols to make sure I’ve optimized lead placement correctly. I also use an advanced lead anchoring technique, so the leads don’t move out of position.

I additionally attribute my success to performing hundreds of neuromodulation trials and implants each year for patients across the country and teaching these procedures nationally.

What is your life like outside of the Main Line Spine medical practice?

It is very important to me that I balance my medical practice with my family life. When you work as hard as I do, it’s crucial to have a great family support system.

My family includes my wife, two daughters, a Savannah cat, and a Belgian Malinois dog. We enjoy outdoor activities including hiking and riding dirt bikes. For me, at the end of the day, it doesn’t get better than that.

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Did you know that approximately 20% of patients who have a total knee replacement continue to experience chronic pain long after the surgery? Researchers are increasingly focusing on understanding the causes of this issue, but the specifics of exactly why this happens have been hard to pin down.

Chronic pain after a total hip replacement is another common issue, which affects approximately 10% of patients.

In fact, far beyond joint replacement pain issues, you may be experiencing chronic pain symptoms in any part of your musculoskeletal system. And you may have tried an epidural, other injections, or other treatments without success.

One of the alternatives that Main Line Spine considers to help patients alleviate pain in these situations are very small and localized peripheral nerve, micro-neurostimulation devices.

What Is Neurostimulation?

At this point, we’ll pause for a moment to answer the question, “What is Neurostimulation?”

Neurostimulation works by delivering mild electrical signals that disrupt nerve pain signals before they reach your brain. In that way, you can achieve pain relief without the need for medication.

Main Line Spine has a long history and deep expertise in helping patients deal with chronic pain by using devices called “neurostimulators.” Traditionally these devices include several components:

  • Neurostimulator: This is a device that generates the electrical impulses and contains a battery. It is usually placed under the skin in your abdomen or upper buttock.
  • Leads: These are thin, insulated medical wires that deliver electrical impulses and which run from the neurostimulator to the epidural space near the spine.
  • Personal Programmer: This is a handheld device that a patient can use after they leave the Doctor’s office to customize their stimulation within the settings a doctor has selected.

These traditional neurostimulators have proven themselves to be very effective for many patients. However, when it comes to relieving chronic pain in a joint such as a knee or shoulder, a much smaller neurostimulator is more appropriate.

This localized approach is known as peripheral neurostimulation. The neurostimulator and leads are placed directly at the nerve identified as causing the pain.

External SPRINT PNS Pulse Generator on a leg for knee pain along with components of SPRINT PNS system.
SPRINT® is one provider of Peripheral Nerve Stimulation (PNS) systems. One application of their model is a 60-day therapy that relieves knee pain without requiring a permanent implant.

Peripheral Micro-Neurostimulators

Peripheral Micro-Neurostimulators are designed for very localized chronic pain relief. They take advantage of many technical innovations developed in recent years, including component miniaturization.

The microstimulators that Main Line Spine uses, in appropriate cases, are the smallest, most-compact neurostimulation systems available. They come with an extremely small neurostimulator that is implanted by your Doctor at your impacted joint.

These neurostimulators have small metal electrodes near the tip that create an electrical field of energy when power is applied. This electrical energy aids in blocking the pain signals that come from certain nerves.

All of these microstimulators offer a variety of programming options that enable you to experience pain relief when and how you need it.

Trial Period

If the conservative care options you’ve tried in the past have failed to alleviate your chronic-pain symptoms, this non-opioid, minimally invasive treatment option might be appropriate for you.

If you decide to move ahead, your Doctor will start you with a trial period to confirm that this peripheral neuromodulation approach will work for you.

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