Neuromodulation: Innovation for the treatment of refractory pain
What is neuromodulation?
Neuromodulation is a form of treatment that modifies the activity of the nervous system through the application of electrical stimuli or the controlled administration of drugs. These treatments act directly on the nerve pathways responsible for pain, with the aim of reducing or even eliminating it.
Instead of blocking pain with drugs, neuromodulation acts on its source, interfering with the nerve signals that cause it. And the best part: in many cases it can be adjusted, customized or even reversed if it doesn’t work as expected.
When is it recommended?
These therapies are mainly used in people with refractory chronic pain, that is, pain that has not improved despite having tried analgesics, physiotherapy, infiltrations or other techniques.
Among the most frequent situations are:
– Pain after spinal surgery (failed surgery syndrome)
– Neuropathic pain (due to nerve damage)
– Complex oncologic pain
– Complex regional pain (CRPS)
– Severe neuralgia (such as trigeminal neuralgia)
– Pain after amputations or spinal cord injuries
Types of neuromodulation: beyond the spinal cord
Stimulation of posterior cords of the spinal cord
It consists of implanting small electrodes in the epidural space to send electrical impulses that “block” the pain signal before it reaches the brain.
Ideal for pain in the back, legs or arms, it has proven to be effective in many patients.
Dorsal root ganglion stimulation (DRG)
It allows a more precise and focal stimulation, ideal for difficult areas such as the groin, foot or knee. It is useful when the pain is very localized or when other forms have not been effective.
Thalamic or cortical stimulation
In very severe cases, such as pain after a stroke, areas of the brain such as the thalamus or the motor cortex are stimulated. These are more complex techniques and reserved for very specific cases.
Intrathecal infusion of drugs
A catheter is implanted and connected to a pump that delivers drugs directly into the fluid surrounding the spinal cord. Fewer side effects and greater efficacy with very small doses.
Peripheral nerve stimulation
Directly stimulates peripheral nerves such as the sciatic. Useful in localized pain after surgery or trauma.
Transcranial magnetic stimulation (TMS)
Non-invasive, magnetic fields are applied to the brain. Useful for fibromyalgia, central neuropathic pain and more. Its effects are not permanent, but can be repeated without significant side effects.
What innovations are there in these treatments?
Some recent improvements include:
– Smaller, more discreet devices
– Stimulation without paresthesia
– Control from mobile or tablet
– MRI compatibility
– Long-life or rechargeable batteries
What are the benefits of neuromodulation?
– Pain reduction (50% or more improvement)
– Reduced need for medication
– Increased physical activity
– Improved sleep and mood
– Customized and adjustable treatment
Are there any risks?
Although it is generally safe, there may be complications such as:
– Infection or hematomas
– Migration of the electrode
– Pain in the area of the generator
– Need for replacement or reprogramming
– In rare cases, lack of efficiency
In a nutshell
Neuromodulation represents one of the great revolutions in the treatment of refractory chronic pain. Today we have multiple ways of acting directly on the nervous system to reduce suffering and improve quality of life.
At MIVI, our commitment is to offer you the most advanced options, adapted to your particular situation, with a human, close and multidisciplinary approach.
Dr. Isaac Peña