Neuromodulation Noninvasive Procedure

Pain Treatment | Procedures

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Neuromodulation Noninvasive Procedure

Peripheral neuromodulation for the treatment of migraine and headache

Noninvasive neuromodulation is a rapidly developing field that offers an attractive nonpharmacologic treatment option for headache patients. Devices that stimulate peripheral nerves (e.g., vagus nerve, trigeminal sensory nerve, somatic sensory nerve) or brain parenchyma (e.g., occipital cortex) have been developed for this purpose. 

How neuromodulation works

Neuromodulation is conducted with a device that uses electrical currents or magnets to adjust or change activity that occurs in the brain. Some of these devices can stop attacks that are already underway, while others are used preventatively. 

These devices are sometimes referred to as stimulators, although they often turn down brain activity rather than stimulate it. Neuromodulation devices can be electrical, temperature-altering, or magnetic. While they can be portable, some require surgical placement. Right now there are a few neuromodulation devices that have been approved by the FDA for headache and are no longer considered experimental. Each of them is labeled by the FDA as “minimal risk,” meaning no significant side effects are known or expected to occur with their use.

How should I prepare for Neuromodulation?

All the neuromodulation techniques that use electrical current-rather than medication-are known as neurostimulation techniques. They “confuse” the pain signals along a nerve by replacing them with a tingling sensation. Neurostimulation is generally offered on a trial basis first; patients who experience relief may have a permanent system implanted. Neurostimulations are mostly outpatient procedures that do not require large surgical incisions. Patients usually need only a local anesthetic.

Our neurosurgeons place a small electrode in whichever location is optimal for each individual patient. Once in position, the electrode generates a weak electrical current that interrupts the transmission of pain. This process is effective, well-tolerated, reversible and can be used to treat many different types of chronic pain. The electrodes may be placed to relieve pain in different regions of the body as follows:

  • Spinal cord stimulation: During this procedure, a small electrode is placed in the epidural space adjacent to the spinal cord. Spinal cord stimulation has been used successfully to relieve pain for more than 40 years in many thousands of patients. It may be used to address abdominal and pelvic pain.
  • Sacral nerve stimulation: Electrodes are placed along the sacral nerves in their spinal foraminae. This procedure can be used to treat many different types of chronic pelvic pain. Some of the most notoriously difficult pelvic pain syndromes may be effectively treated with sacral nerve stimulation. Proctalgia, vulvodynia, and interstitial cystitis are such examples.
  • lntraspinal nerve root stimulation: The electrodes are placed along the nerve rootlets in the spinal canal, rather than over the spinal cord itself. It is used to treat some of the more focal abdominopelvic pain syndromes, such as pain following inguinal hernia repair.
  • Peripheral nerve stimulation: An electrode is surgically placed adjacent to a peripheral nerve. A weak electrical current then inhibits the transmission of painful impulses along that nerve, relieving pain within the area supplied by that nerve. This technique is sometimes used to treat pain syndromes that are not amenable to treatment with other stimulation procedures.

For patients whose pain is not adequately managed by neurostimulation or other treatment options, and who are therefore taking large daily doses of narcotics, neuromodulation by means of a medication pump may offer a better alternative.

Spinal infusion pumps like the intrathecal baclofen pump enable the constant administration of miniscule amounts of potent medications to the spinal cord and nerve roots. The system consists of a programmable pump that contains a reservoir of medication and a spinal catheter to deliver it to the spinal canal. This treatment is also often offered on a trial basis first.

These systems can provide remarkable pain relief, even when all other therapies have failed. Though effective, these systems require periodic refills of medication and vigilance by the patient to make sure the medication does not run out. When the medication runs out, or the system malfunctions, the patient may go into drug withdrawal.

Despite their limitations, spinal infusion pumps have a track record of great success in certain patients where other interventions have failed.

What can I expect after Neuromodulation?

How long will I stay in the hospital?

Exceptions exist, but in general, hospital stay is not required after a neuromodulation procedure.

Will I need to take any special medications?

An intrathecal medication pump will need to be monitored to ensure it does not run out of medication.

Will I need rehabilitation or physical therapy?

No rehabilitation or physical therapy is required.

Will I have any long-term limitations due to neuromodulation?

Quite the opposite−the goal of a neuromodulation procedure is to relieve pain, removing the limitations that have been placed on an individual’s life due to pain