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Neuromodulation

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Abstract

The armamentarium of treatment modalities for chronic pain can be generally divided into rehabilitation, medications (opioids and adjuvants), and interventional procedures. The interventional portion can in turn be categorized as injections (blocks), neuroablation, and neuromodulation. The only category, which has consistently demonstrated long-term efficacy in terms of pain reduction, improvement in function, and decrease in medication, is neuromodulation.

The International Neuromodulation Society (INS) defines neuromodulation as the alteration of nerve activity through the delivery of electrical stimulation and/or chemical agents to targeted sites in the body (International Neuromodulation Society, www.neuromodulation.com, 2015).

These modalities have emerged as some of the key interventions to provide pain relief for patients with chronic pain in the trunk and limbs, who do not have a viable surgical option and have failed conservative therapy. Globally, the modalities for neuromodulation may be separated into:

  1. 1.

    Neurostimulation, which includes spinal cord stimulation (SCS)

  2. 2.

    Intrathecal drug delivery system (IDDS)

Over the past few decades, the technology for neuromodulation has evolved to provide safe, efficient, and cost-effective implantable devices to treat pain. Thus far, low back pain (LBP) has been more challenging to address on a long-term basis with such devices. However, there is now evidence of prolonged pain control for LBP, with the advent of recent developments in this field. New technologies such as HF10 therapy, burst, and dorsal root ganglion stimulation have kindled new interest in the application of neuromodulation for the treatment of chronic pain.

Although neuromodulation, especially neurostimulation, already enjoys a vast central and peripheral neural target application, this chapter concentrates on the treatment of LBP and limb pain with axial disease with these devices. These patients, who may carry such diagnoses as multilevel lumbar degenerative disc disease (lumbar DDD), post-lumbar laminectomy syndrome (FBSS), and chronic lower extremity radiculopathy, may not have a viable surgical option for pain relief. They may have also failed more conservative measures to treat their pain. Such patients comprise the largest portion of candidates for the application of neuromodulation devices. As such, this chapter serves as an introduction to neuromodulation as a cornerstone of chronic pain management for centrally originating axial back and limb pain. The peripheral application of such devices is an expanding field, deserving of its own chapter elsewhere.

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Author information

Authors and Affiliations

  1. IPM Medical Group, Inc., Walnut Creek, CA, USA

    Kasra Amirdelfan M.D. (Medical Director & Director of Research)

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  1. Kasra Amirdelfan M.D.
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Editors and Affiliations

  1. St. Luke’s University Health Network, Neurosurgery, Bethlehem, Pennsylvania, USA

    Steven M. Falowski

  2. Summit Pain Alliance, Santa Rosa, California, USA

    Jason E. Pope

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Amirdelfan, K. (2016). Neuromodulation. In: Falowski, S., Pope, J. (eds) Integrating Pain Treatment into Your Spine Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-27796-7_13

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  • DOI: https://doi.org/10.1007/978-3-319-27796-7_13

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