Neuromodulation

Neuromodulation therapy is a medical approach we use to alter your nervous system, treating diseases and injuries and their symptoms. Medications are a common nonsurgical form of treatment, but neuromodulation is a surgical approach. It involves placing electrodes on your spinal cord or peripheral nerves.

When you experience chronic pain or other neurological conditions, your brain sends abnormal electrical signals to your nervous system. By strategically sending impulses to various parts of your nervous system, we can try to correct these abnormal electrical signals and hopefully decrease your pain.

Our physicians' most common targets are your spinal cord or the small nerves located under your skin. Other areas of your nervous system can also be stimulated, such as your brain or nerve roots. With spinal stimulators, the electrodes are placed on the protective membrane of the spinal cord.

During your surgical procedure, the wires from the electrode are connected to the implantable pulse generator (IPG), where they are attached.

The IPG contains the battery and the circuitry that sends signals to the electrode. The circuitry is programmed to send signals that maximize the effect of the electrodes.

If you have been seeking relief from chronic pain and other nerve or spine care treatments have failed, a neurostimulator might be right for you. A neurostimulator — sometimes informally called a "brain pacemaker" — can help you with:

• Pain that lasts longer than six months
• Long-lasting pain following your surgery
• Obtaining beneficial therapy that no longer produces unwanted side effects

Many people experience meaningful pain relief through neurostimulation. However, before you commit to a permanent neurostimulator, we have you start with a trial period spanning seven to 10 days of stimulation. During your trial, you record notes to see if the stimulation is effective. After the trial, if you are satisfied with your results, we will then make a plan with you for permanent implantation.

There are two ways a stimulation trial can be conducted. One is with temporary percutaneous leads, and the other is with paddle leads. Both approaches have their upsides and downsides, but our experts can help you decide which trial type is right for you.

Paddle leads

A paddle lead trial is performed in two surgical stages separated by about one week. In the first stage, the paddle leads are placed surgically and then attached to a temporary extension cable that is brought through your skin. This procedure usually requires an overnight hospital stay. The stimulation is then tested for one week during which you track pain levels, the amount of pain medicine you take and your activity level. One week later, you'll meet with our neurosurgical team to assess the results of the trial. If the trial is successful in reducing or eliminating your pain, we implant a permanent pulse generator to connect to the paddle leads. If the trial is unsuccessful, we'll remove the paddle leads, and nothing is implanted. The second surgery typically takes place the next day and is an outpatient procedure.

Percutaneous leads

A trial with percutaneous leads — leads implanted through your skin — is a minimally invasive outpatient procedure performed under conscious sedation. Temporary stimulator wires are placed in the body through your skin and guided to areas that provide you with relief. Once the stimulator wire is taped in place, you go to the recovery room while the sedation is wearing off.

In the recovery room, the stimulator will be programmed to give you the best overall pain relief. You wear the stimulator for seven to 10 days while tracking pain, medication and your activity level.

During that time, if you decide it had a positive effect on any of those parameters, then you are scheduled for permanent implantation of an electrode and an IPG.