Neuromodulation entails the use of an implantable device to make changes in the activities of the nervous system. This is made possible via the release of little medication doses or with the use of weak electrical current. By manipulating some orders in the nervous system, it is possible to avert pain instantly and significantly. Stimulation or application of medications to the nervous system for the purpose of therapy is a major constituent of neuromodulation. It can be engaged to treat spasticity, movement disorders, epilepsy, and pain syndromes. The most famous type of neuromodulation is spinal cord stimulation. It is usually used for the treatment of back or lower extremity pain.
Below are other forms of neuromodulation
Deep Brain Stimulation (DBS)
This is a bit intense stimulation. It is a mild electrical stimulation in the brain used to alter movement control, particularly on either the internal globus pallidus, subthalamic nucleus or the ventral intermediate nucleus of the thalamus.
Peripheral Nerve Stimulation (PNS)
This neuromodulation entails the target of a particular nerve and use for pain relieve locally
Spinal Cord Stimulation (SCS)
In this form of neuromodulation, the nervous tissues on a particular spinal cord portion are stimulated electrically to avert pain signals to the brain.
Neuromodulation is made up of three surgically implanted parts which are:
- Extension wires
This is used to connect the electrodes with the neurostimulator. - Lead
These are wires that are uniquely insulated with an electrode at the tip. They are used to produce some electrical pulses. - A Neurostimulator
This is an electronic device that looks like a cardiac pacemaker. This device is often implanted either below the skin in the abdomen for SCS or implanted for DBS in the upper chest. After it has been successfully programmed, neurostimulator forwards mild electrical pulses through the insulated lead to a particular part of the spinal cord, the brain or nerves to prevent the transmission of pain causing signals or movement disorders signal.
An expert Surgeon may take up to six hours to carefully implant neuromodulation system.
Spinal Cord Stimulation
This is the stimulation of the spinal cord to halt painful feelings from the spinal cords to the brain and substitute such for a pleasant feeling. The device in used is made up of electrical leads, a remote programmer as well as implanted battery to produce therapeutic electrical current doses in the spinal cord. This then leads to the relief of neuropathic pain. A major merit of this procedure is the fact that pain is treated without medications. This lowers the rate of side effects.
Another great merit of the spinal cord stimulation is in its opportunity to build a trial system, with battery and temporary external leads which are used to determine the pain relief with the permanent aftermath.
It is a tested and trusted therapeutic solution for severe pain of the legs, neck, back, and arms most of the time after neuropathic conditions or spine surgery. Also, further development is being made in line with the treatment of pelvic pain, non-cardiac chest or angina pain including severe abdominal pain that is not as a result of inflammatory bowel disease.
Finally, patients with the peripheral vascular disease are discovered to have enhanced blood flow after spinal cord stimulation procedure. Not like most interventional therapies, spinal cord stimulators can be examined on trial basis at home within 5-7 days.
Peripheral Nerve Stimulation
Peripheral nerve stimulation is a procedure by which an electrode is surgically inserted opposite to a peripheral nerve. The painful feelings that the nerve ought to transmit are then interrupted by a weak electrical current. This then leads to a reduction in the pain sensation. This process is sometimes used to treat pain syndromes that other stimulation cannot treat.
Deep Brain and Cortical Stimulation
This is a different neuromodulator which makes use of deep brain stimulation. It then treats movement disorders and diseases like Parkinson when it delivers electrical current to the deep nuclei of the brain. At the moment, epilepsy is being treated with deep brain stimulation.
Cortical stimulation is more adopted for epilepsy treatment, and as well used to treat diverse pain syndromes forms, such as neuropathic pain. Peripheral nerve stimulation which was once adopted to treat epilepsy has now become a treatment procedure for neuropathic neck pain and regions of local pain.
Intrathecal Drug Delivery
This includes the use of drug delivery devices. This is the use of neuromodulator treatment which involves the use of implantable pumps to deliver medication to a particular place. This uses little dosages bringing about reduced side effects. Intrathecal implants are nothing but storage and delivery pumps for medication via the catheter into the intrathecal space close to the spinal cord.
A trial intrathecal injection is firstly carried out before implanting intrathecal pump. This is to test the efficiency of the medication which could be a muscle relaxant like baclofen.
A pump may help reduce severe pain caused by:
- Complex Regional Pain Syndrome
This is a continuous nervous system disease in which patients constantly feel severe burning pain. - Failed back surgery syndrome
One or more surgeries carried out may fail to alter the persistent pain of the leg (sciatica). This doesn’t necessarily mean that the technical procedure failed.
Peripheral neuropathy
A pump can assist in the reduction of spasticity which is the rate of muscle rigidity and spasms which inhibit movement of the arms and legs. This may be caused by:
- InjuryOfthe Brain
- Cerebral palsy: This is a nervous disorder which impedes the control of body movement.
- Stroke: This is damage done to the brain as a result of lack of oxygen. This is due to the blood supply interruption.
- Multiple sclerosis: This is a brain disorder as well as that of the spinal cord resulting from the damage of nerve cell’s outer layer (myelin).
- Spinal cord injury
A noninvasive stimulation which is drug-free is called Transcutaneous electrical nerve stimulation. It is a method of pain control with the use of a device with electrodes that are attached to the skin. Evidence abounds indicating a reduction of severe musculoskeletal pain. It may as well be used in diabetic neuropathy.
Another well-researched neuromodulation is the Electrical muscle stimulation. It is widely reckoned within the pain management rehabilitation field. Also in the treatment of neuromuscular dysfunction, blood flow, improvement of joint range mobility, tissue repair and absorption of edema.
