Neuromodulation

What is neuromodulation?

Neuromodulation is any technique that modifies nerve function. This includes electrical as well as pharmacological (drug) methods. In current pain medicine usage, this means any electrical technique that reduces pain.

The most commonly used form of neuromodulation in Australia is spinal cord stimulation, although this technique can be used on pain nerves in other parts of the body.

Will I benefit from this?

That depends.

For people with back pain after spinal surgery, with appropriate selection, about 80% of people will get at least a 50% reduction in their pain level. This still means that not every person gets significant benefit but many do.

The types of pain that have the strongest evidence for reducing their pain include:

  • Pain after spinal surgery
  • Pain from complex regional pain syndrome
  • Pain from poor blood supply that cannot be fixed with surgery
    • This is typically small vessel disease too small to stent

Neuromodulation can work for other types of pain, but the evidence base is less clear. This is mostly because it has not been well tested in clinical trials in areas other than outlined above.

What’s involved in a trial?

Before you get to a trial, you would generally look at less invasive options for managing your pain, such as medications and rhizotomy, although this has to be tailored to the specific pain you have.

Where practical, the workup to the trial may require further imaging depending on lead placement requirements. You also may require further assessment by our multidisciplinary team.

The lead trial

The trial itself requires placement of trial leads, generally done with an overnight stay in hospital. The leads are placed under sedation, and may require feedback during the procedure. Depending on lead placement, this is generally similar to positioning an epidural catheter commonly done during childbirth, although the specifics of this depend on the location of the trial leads.

A small external device is worn during the trial phase to deliver the treatment. It is generally taped to you. As this is an electrical device, it cannot be immersed or exposed to water during the trial phase.

You will need to wear the trial leads for a period of weeks, and the device programming may need to be adjusted during this period.

The aims of the trial phase are to:

  • Establish if this type of device can help reduce your pain.
  • Determine what sort of device will work for you.

At the end of the trial, the leads are removed to allow recovery.

The permanent device

If you have a successful trial, then you will go on to a permanent device implantation. This is generally done several weeks after the trial is finished to allow recovery from the trial.

The insertion is generally done under full anaesthesia, and it involves making surgical incisions to place the device in a pocket under the skin as well as to secure the leads so they do not move.

Although the device can be turned on at any stage after insertion (typically once you have recovered from the anaesthetic), the leads are still at risk of moving for many weeks after the operation. You will need to avoid doing anything that involves heavy lifting, bending or twisting for this period whilst you recover from the surgery.