There are many areas of neurotechnology in the treatment of pain. This is an overview of three basic areas of treatment that are currently available; transcutaneous electrical nerve stimulation (TENS) or percutaneous neuromodulation units (PENS), implanted drug delivery systems (IDDS) and spinal cord stimulators (SCS).
- TENS units (transcutaneous electrical nerve stimulation) and Percutaneous Neuromodulation Units (PENS) work by delivering low level electrical stimulation through electrodes placed directly on the skin of the affected area. The electrical stimulation delivered through the skin may help alleviate pain by blocking pain messages being sent to the brain. Both systems require a physician prescription but this therapy can provide a convenient means of treating some forms of pain. Both are non-invasive and can be an economical solution.
- Implanted Drug Delivery Systems (IDDS), also known as Intrathecal Analgesia Therapy, refers to the administration of medicine, either pain-relieving or spasticity-relieving, such as baclofen, by a medication delivery pump. The IDDS include a chamber or reservoir for the drug that delivers the medication through a catheter directly into the spinal canal (intrathecal). The pump needs to be refilled, usually once every few months, by placing a needle through the skin. This procedure is typically performed on an outpatient basis or during a regular doctor’s visit. Generally, a person first undergoes a trial of the medication by an intrathecal injection. If successful, a pump system can be implanted permanently through a surgical procedure. IDDS reduce the need for oral medications, can be more effective and is now a mainstay of therapy for intractable pain including neuropathic pain and spasticity.
- Spinal Cord Stimulation (SCS) system is a hybrid system comprised of implanted electrodes in the spine and an external control unit. It uses electrical stimulation to block the pain pathways to the brain that travel through the spinal cord. SCS has also been known to decrease spasticity. An initial trial is needed to see if effective results can be achieved. If the trial is successful, a permanent system may be implanted. The user has the ability to keep the system on permanently or as needed.
These above options should be discussed with a medical professional trained in interventional pain medicine. Deep brain stimulation, transcranial magnetic stimulation and the use of very high frequency alternating currents as a method for blocking nerve conduction in peripheral nerves is currently under investigation. These methods might be able to provide an improved alternative for blocking pain and controlling muscle spasms. To discover more about available clinical trials, visit www.clinicaltrials.gov
Special appreciate to Dr. Elliot Krames, MD, International Neuromodulaton Society and Dr. Thomas Keller, MD, Pacific Pain Treatment Centers for their contribution creating this introduction
Types of Neuropathic Pain
- Neuropathy Neuropathic pain arises from nerve injury, as the INS describes in this overview about this chronic condition that lasts from months to years. A Fact Sheet of a further description of Neuropathy; courtesy of INS
- Neuropathic Pain Since the 1980s, neurostimulation has been an option for controlling symptoms of chronic neuropathic pain, and use of the therapy continues to spread as the technology itself advances. A Fact Sheet of a further description of Neuropathic Pain; courtesy of INS
- Painful Peripheral Neuropathy The INS explains this condition as “a common neurological disorder characterized by numbness, weakness, tingling and pain, often starting in the hands or feet”. A Fact Sheet of a further description of Peripheral Neuropathy; courtesy of INS
- Complex regional pain syndrome (CRPS) The key symptom of CRPS is continuous, intense pain out of proportion to the severity of the injury, which gets worse rather than better over time. CRPS most often affects one of the arms, legs, hands, or feet. Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. A Fact Sheet of a further description of CRPS; courtesy of NINDS
There are a variety of applications which are listed below by category. Prior to considering any new therapy, treatment or device, a proper evaluation should be conducted with a knowledgeable medical professional. There are health, medical and financial risks. Out of pocket costs and available insurance coverage for any treatment must be considered prior to starting a protocol. Also, it is key to understand that results and applications will vary depended on symptom and function limitations related to the condition. If you find something of interest, please contact the vendor directly to find a trained professional in your area.
Support Groups & Resources
- American Academy of Pain Management – The American Academy of Pain Management is an inclusive, interdisciplinary organization serving clinicians who treat people with pain through education, setting standards of care, and advocacy.
American Chronic Pain Association – The American Chronic Pain Association was founded in 1980 by Penney Cowan in Pittsburgh, Pennsylvania.
American Pain Foundation – Raising public awareness, providing practical information, promoting research, and advocating to remove barriers and increase access to effective pain management.
NIH Neurological Disorders and Stroke – Chronic Pain – NINDS Chronic Pain Information Pages.
U.S. Pain Foundation – A non-profit created by people with pain for people with pain to help inform, connect, educate and empower the pain warrior.