Learn More About Neuromodulation



NEUROMODULATION

Definition

According to the International Neuromodulation Society, neuromodulation is defined as “the alteration of nerve activity through targeted delivery of an input, like electrical stimulation or chemical agents, to specific medicine sites within the body.” In other words, neuromodulation technology alters abnormal neural behaviour in the brain, spine, or peripheral nerves to relieve pain or restore normal function or bodily control. Nerve stimulations are typically administered with a variety of pharmaceutical agents, electrical signals, or other forms of energy.

Why You May Need This Type of Treatment

For generations, physicians were intrigued by the potential for electrical impulses within the body to produce therapeutic benefits. The era of neuromodulation began in the early 1960’s with the utilization of deep brain stimulation (DBS) to resolve chronic and defiant pain. It evolved to incorporate neural structure stimulation by the end of the last decade.

Neuromodulation devices and treatments are life changing. They have an effect on each space of the body and treat nearly every malady or symptom from headaches, tremors, spinal cord damage, and urinary incontinence. This minimally invasive procedure is typically suggested as supplementary care in conjunction with another treatment, or when symptoms don’t respond to more conservative measures. With such a broad therapeutic scope, and progress in biotechnology, it's no surprise that neuromodulation is poised to be a very progressive industry in the coming years.

While neuromodulation is most commonly associated with pain relief, there are other treatment applications such as Deep Brain Stimulation (DBS) for Parkinson's, Sacral Nerve Stimulation for pelvic disorders and urinary incontinence, and Spinal Cord Stimulation for ischemic disorders (angina, peripheral vascular disease etc.).

Procedure of Neuromodulation

Neurostimulation devices involve the application of electrodes to the brain, the spinal cord or peripheral nerves. They connect via an extension cable to a pulse generator and power supply that generates the required electrical stimulation. A low-tension electrical current passes from the generator to the nerve and might either inhibit pain signals or stimulate neural impulses wherever they were not present previously.

In the case of pharmacological agents delivered through implanted pumps, drugs are often administered in smaller doses because they don’t need to be metabolized and passed through the body before reaching the target point. Smaller doses will mean fewer adverse effects, enhanced patient comfort, and improved quality of life.

Neuromodulation approaches vary from non-invasive techniques like transcranial magnetic stimulation to implanted devices, such as spinal cord stimulation or deep brain stimulation. The device is considered a long-term solution to your on-going symptoms, and is therefore normally a permanent implant.

The most common neuromodulation treatment is spinal cord stimulation for chronic neuropathic pain. In addition to chronic pain relief, alternative neuromodulation treatments have been shown to help aid patients experiencing tremors, Parkinson’s disease, dystonia, epilepsy and disorders like depression, obsessional compulsive disorder and Tourette syndrome.

Providers of such therapies embrace neurosurgeons, pain physicians, specialists and rehabilitation physicians. They will typically work with alternative specialists like neurologists, psychiatrists, psychologists, gastrointestinal or colorectal specialists, urologists, primary care physicians, and physical therapists to achieve the best outcomes.

Duration of Treatment

Duration of neuromodulation varies depending on the type of condition being treatment and if it is non-invasive or implanted. Consult your provider on what the best approach is for you.

Recovery After Treatment

While recovery normally takes about a week, the exact amount of time required to recover from these treatments will depend upon several patient-specific factors. It’s always best to check with your neuromodulation team for the most accurate estimation.

Possible Risks and Side Effects

There are complications that are general to any implant into the body and complications that are specific to the technique, therapy and disease. Common adverse effects include skin irritation, headache and general uneasiness. You should ask your doctor about any common or dangerous possible side effects before embarking on a new treatment.

Consult the Team at Northern Arizona Pain Institutes

Before moving forward with treatment such as the sacroiliac joint block procedure, you should always consult a professional to discuss other options, possible risks and side effects, long-term effects, and any other questions you may have. The team at Northern Arizona Pain Institutes is highly qualified professionals and can be a helpful resource when considering any type of pain-reducing treatments. Please visit our website to learn more about procedures or to book an appointment: northernarizonapaininstitutes.com.








References


Amann W, Berg P, Gersbach PA et al. Spinal cord stimulation in the treatment of non reconstructable stable critical leg ischaemia: results of the European peripheral vascular disease outcome study (SCS-EPOS). Eur J Vasc Endovasc Surg 2003; 26:280-286.

Blok, B.F., et al., Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int, 2006. 98(6): p. 1238-43.

Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: A 20-year literature review. J Neurosurg Spine 100(3):254-267, 2004.

Deer, T. R., Lamer, T. J., Pope, J. E., Falowski, S. M., Provenzano, D. A., Slavin, K., Golovac, S., Arle, J., Rosenow, J. M., Williams, K., McRoberts, P., Narouze, S., Eldabe, S., Lad, S. P., De Andrés, J. A., Buchser, E., Rigoard, P., Levy, R. M., Simpson, B. and Mekhail, N. (2017), The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury. Neuromodulation: Technology at the Neural Interface. doi:10.1111/ner.12564

Deer, T. R., Narouze, S., Provenzano, D. A., Pope, J. E., Falowski, S. M., Russo, M. A., Benzon, H., Slavin, K., Pilitsis, J. G., Alo, K., Carlson, J. D., McRoberts, P., Lad, S. P., Arle, J., Levy, R. M., Simpson, B. and Mekhail, N. (2017), The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices. Neuromodulation: Technology at the Neural Interface. doi:10.1111/ner.12542

Deer, T. R., Provenzano, D. A., Hanes, M., Pope, J. E., Thomson, S. D., Russo, M. A., McJunkin, T., Saulino, M., Raso, L. J., Lad, S. P., Narouze, S., Falowski, S. M., Levy, R. M., Baranidharan, G., Golovac, S., Demesmin, D., Witt, W. O., Simpson, B., Krames, E. and Mekhail, N. (2017), The Neurostimulation Appropriateness Consensus Committee (NACC) Recommendations for Infection Prevention and Management. Neuromodulation: Technology at the Neural Interface. doi:10.1111/ner.12565

Ekre O et al. Long-term effects of spinal cord stimulation and coronary artery bypass grafting on quality of life and survival in the ESBY study. Eur Heart J 2002;23:1938– 1945.

Hassouna, M.M., et al., Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol, 2000. 163(6): p. 1849-54.

Kumar K et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomised controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery 2008;63(4):762–770.

International Neuromodulation Society. Welcome to the International Neuromodulation Society. www.neuromodulation.com. Accessed Dec. 21, 2016

Krames, Peckham, and Rezai (eds) Neuromodulation v.1-2, (2009) (excerpted with permission of the author); 2nd edition (2018)

Krames, E., Poree, L. R., Deer, T. and Levy, R. (2009), Rethinking Algorithms of Pain Care: The Use of the S.A.F.E. Principles. Pain Medicine, 10: 1–5

Krames E et al. Using the SAFE principles when evaluating electrical stimulation therapies for the pain of failed back surgery syndrome. Neuromodulation 2011;14:299– 311.

Levy R, Deer TR, Henderson J. Intracranial neurostimulation for pain control: a review. Pain Physician. 2010;13(2):157-165.

Mekhail NA, Cheng J, Narouze S, Kapural L, Mekhail MN, Deer T. Clinical applications of neurostimulation: forty years later. Pain Pract. 2010;10(2):103-112.

North RB et al. Spinal cord stimulation versus re-operation in patients with failed back surgery syndrome: an international multicenter randomised controlled trial (EVIDENCE Study). Neuromodulation 2011;14:330–6.

Sharan AD, Rezai AR. Neurostimulation for Epilepsy. In: Krames ES, Peckham HP, Rezai AR, eds. Neuromodulation. London: Elsevier; 2009:617–66.

Simpson, EL, Duenas, A, Holmes, MW, Papaioannou, D, Chilcott, J. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation. Health Technol Assess. 2009 Mar;13(17):iii, ix-x, 1-154.

Spincemaille GH, de Vet HC, Ubbink DT et al. The results of spinal cord stimulation in critical limb ischaemia: a review. Eur J Vasc Endovasc Surg 2001; 21:99-105.

Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost effectiveness literature and assessment of prognostic factors. Eur J Pain. 2006;10(2):91-101.

Thomson S, Jacques L. Demographic characteristics of patients with severe neuropathic pain secondary to failed back surgery syndrome (PROCESS study). Pain Practice 2009;9:206-214.

Weaver FM, Follett K, Stern M, et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009;301(1):63-73.

Wilkinson HA. Spinal cord stimulation versus reoperation for failed back surgery syndrome: A cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery. 2008;63(2):E376.

Zesiewicz TA, Sullivan KL, Arnulf I, Chaudhuri KR, Morgan JC, Gronseth GS, et al. Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology . 2010 Mar 16;74(11):924-31.

Comments

Popular posts from this blog

Northern Arizona Pain Institutes offers Fluid Flow™

Acupuncturist, Ted Fulop LAC, Joins Northern Arizona Pain Institutes in Prescott, AZ

Northern Arizona Pain Institutes’ Robert J. Brownsberger M.D. leads Pain Management Efforts in Prescott, Flagstaff and Show Low, Arizona