Neuromodulation: Innovative Approaches to Chronic Pain
SCS influences the transmission of neural impulses using electrical signals. This procedure is minimally invasive, non-destructive to tissue, and reversible.
The choice of neuromodulation depends on various factors and is made in a stepwise manner within an interdisciplinary team. The main indications include neuropathic pain, chronic spinal disorders, postoperative pain, and peripheral arterial occlusive disease (PAOD).
Neuromodulation is often considered symptomatic treatment since chronic pain is frequently incurable. The primary treatment goals are:
- Significant pain reduction
- Improved quality of life
- Reduction in medication use
- Retention of work capability
The aim of SCS is to influence and suppress pain signals at the dorsal horn of the spinal cord. This is achieved through electrical impulses delivered via cylindrical electrodes (less commonly paddle electrodes) placed in the epidural space. The impulse generator (IPG), similar to a pacemaker, stimulates the dorsal column, which transmits pain signals from the periphery to the central nervous system.
A wide range of stimulation programs exist, varying by manufacturer. These are broadly divided into two main categories:
- Low-frequency stimulation with tingling paresthesias
- High-frequency stimulation without sensory side effects
SCS is suitable for the following pain conditions:
- Therapy-resistant back pain (PSPS Type 1)
- Pain after spinal surgery (PSPS Type 2/FBSS)
- Complex Regional Pain Syndrome (CRPS)
- Peripheral and central neuropathic pain (e.g., radiculopathy, polyneuropathy)
- Peripheral arterial occlusive disease (PAOD)
The treatment is conducted in two stages:
Trial Phase (SCS Trial):
- Minimally invasive placement of electrodes
- A trial period of 1 to 4 weeks to evaluate efficacy
- Outpatient adjustment of stimulation parameters
Permanent Implantation:
- Performed only if significant pain reduction and improved quality of life are observed
- The neurostimulator is implanted under the skin in a second surgery
If the trial phase is unsuccessful, the electrodes can be easily removed.
Possible complications include:
- Bleeding or nerve injury
- Electrode displacement
- Infections or lead fractures
- Loss of stimulation effectiveness
In addition to SCS, alternative procedures include:
- Pulsed radiofrequency treatment
- Peripheral nerve stimulation (PNS)
- Dorsal root ganglion stimulation (DRG stimulation)
- Occipital nerve stimulation (ONS)
- Intrathecal pain pumps
Neuroablative techniques, such as thermoablation and cryoablation, are also options for pain management.
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The term neuromodulation encompasses a variety of established therapeutic methods, including not only spinal epidural neurostimulation (Spinal Cord Stimulation – SCS), which is often used
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Since October 25th, we have been using PraxisConcierge as a digital phone assistant. PraxisConcierge is an artificial intelligence (AI) integrated into our telephone system.
New at ISSZ – Practice Concierge
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