Neuromodulation is one of the fastest-growing areas of medicine, involving many diverse specialties. When used for pain relief, it involves neural stimulator implantable devices. These therapies work by interrupting pain signals before they reach your brain. They can help with non-opioid pain relief – even when other therapies have failed.
The modern era of neuromodulation dates back to 1967, when Dr. Norman Shealy, a neurosurgeon, implanted the first device for the relief of intractable pain. Many credit his work as ushering in a new era for chronic pain management.
Neuromodulation pain management therapies have been in common use since the 1980s.
How They Work
Most neuromodulation systems for pain management work by using mild electrical stimulation. They typically consist of the following components:
- An electrode or multiple electrodes which are placed by surgical implantation of paddle or grid electrodes, or minimally invasive needle techniques.
- A pulse generator.
- An implanted or external battery, rechargable or replaceable.
- An external programmable remote controller that patients can use to activate electrical impulses when they feel pain.
The most common examples of neuromodulation systems include:
- Spinal Cord Stimulation (SCS) systems: Systems consisting of very thin leads (or wires) that are placed in the epidural space just outside the spinal cord. These leads are attached to a small generator device and battery that is implanted under the skin and subcutaneous layer in the back or buttock.
- Dorsal Root Ganglion (DRG) systems: Devices to stimulate the dorsal root ganglion that became available in the mid-2010s to treat chronic pain situations that weren’t addressable by traditional spinal cord stimulation.
- Peripheral Nerve Stimulation (PNS) systems: A new class of treatment systems where stimulators are placed directly near or on the peripheral nerve that has been identified as causing the pain. These systems are often used for knee, shoulder, or other joint pain, as well has to address pain at any peripheral nerve below the head in the body.
All of these devices deliver frequent, low-voltage electrical impulses, which modulate pain signals as they transit to the brain. These impulses are often described as feeling like a gentle tingling or buzzing. In past decades there have been significant advances in neuromodulation hardware and technology, and over that time, patients have reported better ability to control their pain while feeling less of the vibrations.
While spinal cord stimulation and dorsal root ganglion systems are typically most appropriate for chronic pain, peripheral nerve stimulation systems can be effective with both acute as well as chronic pain.
A trial stimulation period is always conducted before permanently implanting a neurostimulation device. During this trial period, which typically will last 3 to 7 days, the focus is on whether the device is providing satisfactory pain relief, and that each patient is comfortable with how it operates and feels.