Neuormodulation and Chronic Neuropathic Pain
Neuromodulation refers to a method of treatment of chronic neuropathic pain. This method includes the delivery of electricity to the nerve fibre responsible for the individual’s pain. This modality of electrical stimulation allows for a direct impact at the source of the neurological issue.
Patients with chronic intractable neuropathic pain often fail to benefit from conventional treatments such as drug therapy and have few options for pain relief. Of the current technologies, Spinal Cord Stimulation or SCS has received the most attention. For patients with chronic pain in the trunk and/or limbs resulting from dysfunction or damage to the nervous system through injury, disease or localized trauma, this mode of neuromodulation has good results.
More recently, there has been the application of electrical stimulation subcutaneously, rather than accessing the epidural space. Stimulation in the peripheral areas have shown promising results for patients with chronic neuropathies. Since chronic pain can lead to a reorganisation in the central nervous system, it is plausible that successful pain reduction can be achieved in the periphery rather than at the spinal cord. This technique is known as Subcutaneous Electrical Nerve Stimulation or SENS.
Patients with hyperalgesia (an increased sensitivity to painful stimuli) and allodynia (painful reaction to otherwise non-painful stimuli) present an interesting challenge in the management of pain. Peripheral stimulation is gaining popularity as a method of managing this group of patients as the precise target can be addressed.
Managing the primary area of hyperalgesia or allodynia may uncover subsequent areas of pain, since the nature of SENS implantation ultimately produces new scars such as those relating to the IPG implant site, that may also not heal properly, new pain areas may emerge making this mode of treatment futile in a sub-set of this patient population.
These observations have led to a method of percutaneously delivering electrical stimulation for a brief period of time to induce analgesic effects and facilitate a normalisation of central processing. Percutaneous Electrical Nerve Stimulation or PENS is a viable option for managing pain directly at the painful site.
London Pain Consultants
