Neuromodulation for Painful Neuropathic Conditions

People with peripheral neuropathy often experience symptoms such as weakness, numbness, tingling, and pain in the hands or feet. Studies show that over 15 million people in the United States and Europe have some type of neuropathy. Many times after injury or illness, the ends of the nerves will become sensitized, and this signals pain. The nerve cell’s outer sheaths (the myelin coatings) are affected causes interruptions in nerve signals, which results in neuropathy.Peripheral Neuropathy2

Symptoms of Painful Peripheral Neuropathy

The symptoms of painful peripheral neuropathy vary according to the type of the condition. Pain if usually worse at night and sometimes interrupts sleep. The pain can be constant or reoccurring and could feel like electric shocks, burning, numbness, stabbing, pins, prickles, and even needles. Diabetic polyneuropathy is usually noticed in the feet or hands and work toward the middle of the body.

The pain of neuropathy can be severe for some especially with particular stimulus. Just a touch can bring on pain in people with this condition. The pain may feel odd or different than regular pain caused by injury of a normal nature. Many times pain will be felt through temperature or vibration. It can also affect the motor nerves as well as the autonomic nerves, which control the physiological aspects of the body, such as our blood pressure. This can cause muscle weakness or light-headedness.

New Treatment for Chronic Neuropathic Pain

There is treatment for chronic neuropathic pain opposed to taking anticonvulsants and painkillers. It is a type of stimulation called electrical neuromodulation technique. The technique involves a pulse wave going through a series of electrode inside a lead. It stimulates afferent nerve fibers, spinal dorsal columns, and cortical brain areas. The implantable pulse generator generates the pulse wave. It also has a battery pack with an electronic module, which allows for external programming. Even though it’s well known, the external trial stimulation period used to key in the potential response before the programmed pulse generator implantation is not used world-wide.

Electrical neuromodulation techniques are quite costly, but they pay off long in the long run. In order to be successful, neurophysiologists must carefully select patients, have a clear and thorough understanding of anatomy, and performing these procedures with expertise. There are several stimulation techniques which are being used. The choice of stimulation technique depends on the specific type of neuropathic pain. These include:

  • Motor cortex stimulation (MCS)Spinal-Cord-Stimulator3-300x190
  • Peripheral nerve field stimulation (PNFS)
  • Spinal cord stimulation (SCS)
  • Peripheral nerve stimulation (PNS)
  • Deep brain stimulation (DBS)

Peripheral Nerve Stimulation

Neuropathic pain conditions can be treated alone with PNS or with other forms of electrical neuromodulation procedures. PNS is an excellent quality treatment for many types of neuropathic pain. Also, SCS and DBS are effective neuromodulation techniques, but to affect certain nerves distribution, PNS is better.

Direct exposure of the nerve with paddle or cylindrical lead implanted next to it is one approach to lead implantation. Another approach involves the use of a percutaneous lead implant, which is inserted with a needle perpendicular to the course of the nerve. Before having permanent electrode and the IPG implant, it’s best for the patient to do a trial stimulation to acquire a reaction with SCS, which is customary.