Though neurostimulation therapy was developed several decades ago, a new device approved by the FDA in November has pain management specialists taking a fresh look at the treatment for chronic back pain.
Edward Tavel, MD, medical director of Pain Specialists of Charleston (Pa.), calls spinal cord stimulation "a game changer" in the field of pain management. While neurostimulation has been around since the 1960s, he says, improved technology and delivery systems are expanding treatment options for chronic, refractory pain.
"Neurostimulation candidates suffer from neuropathic pain – not bone or arthritic pain – and these patients have had multiple failed surgeries or multiple injuries," Dr. Tavel says. "They have tried TENS units and medication with little or no relief. For these patients, neurostimulation provides one, final opportunity for treatment."
How it works
Neurostimulation therapy centers around a programmable, implantable device similar to a cardiac pacemaker, says Naum Shaparin, MD, director of pain service at Montefiore Medical Center in New York City. The implantation consists of electrodes placed into the patient’s epidural space, he says. The electrodes are then tunneled and connected to a battery implanted below the skin over the patient’s buttock.
Unlike a TENS unit that operates on a surface level, neurostimulation targets pain in the spinal column by blocking pain signals before they reach the brain.
"Once the patient receives permanent spinal cord stimulator placement, they have very little lifestyle limitations," Dr. Tavel says. "Patients with permanent spinal cord stimulator placement are able to have reduced or eliminated need of medication. For patients who have battled chronic pain for years, neurostimulation has the ability to change their life."
New technology
In past years, the effectiveness of neurostimulation treatment was dependent on a patient's body position, says Dr. Shaparin. But with updated devices, including the Medtronic AdaptiveStim with RestoreSensor system, he is able to treat chronic pain syndromes of the back and leg without the traditional limitations.
"The main limitation of neurostimulation has always been that body position – for example, sitting up or lying down – often resulted in significant changes: either a decrease or increase in the intensity of the stimulation as the spinal cord moves further and closer from the site of stimulation with patient movement," says Dr. Shaparin.
The Medtronic AdaptiveStim, however, senses the patient's position and adjusts stimulation accordingly. According to George Mandybur, MD, neurosurgeon with the Mayfield Clinic for Brain & Spine in Cincinnati, Ohio, the device incorporates an accelerometer similar to the motion sensor technology used in smart phones and computer gaming systems.
"It frees patients from continually making manual adjustments to stimulation levels as they move about during the day," says Dr. Mandybur. "The advantage of the new sensor stimulator over previous stimulators is that it will 'learn' how to adapt to the individual’s positioning."
Incorporating it into your practice
In late 2011, following the FDA's approval of the Medtronic device, Dr. Mandybur implanted a new spinal cord stimulator for treating chronic pain in a patient suffering from reflex sympathetic dystrophy.
"Implanting the RestoreSensor is exactly the same as implanting its technological predecessors," he says. "There is no change in the surgical techniques, and there is no increased risk to the patient."
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Edward Tavel, MD, medical director of Pain Specialists of Charleston (Pa.), calls spinal cord stimulation "a game changer" in the field of pain management. While neurostimulation has been around since the 1960s, he says, improved technology and delivery systems are expanding treatment options for chronic, refractory pain.
"Neurostimulation candidates suffer from neuropathic pain – not bone or arthritic pain – and these patients have had multiple failed surgeries or multiple injuries," Dr. Tavel says. "They have tried TENS units and medication with little or no relief. For these patients, neurostimulation provides one, final opportunity for treatment."
How it works
Neurostimulation therapy centers around a programmable, implantable device similar to a cardiac pacemaker, says Naum Shaparin, MD, director of pain service at Montefiore Medical Center in New York City. The implantation consists of electrodes placed into the patient’s epidural space, he says. The electrodes are then tunneled and connected to a battery implanted below the skin over the patient’s buttock.
Unlike a TENS unit that operates on a surface level, neurostimulation targets pain in the spinal column by blocking pain signals before they reach the brain.
"Once the patient receives permanent spinal cord stimulator placement, they have very little lifestyle limitations," Dr. Tavel says. "Patients with permanent spinal cord stimulator placement are able to have reduced or eliminated need of medication. For patients who have battled chronic pain for years, neurostimulation has the ability to change their life."
New technology
In past years, the effectiveness of neurostimulation treatment was dependent on a patient's body position, says Dr. Shaparin. But with updated devices, including the Medtronic AdaptiveStim with RestoreSensor system, he is able to treat chronic pain syndromes of the back and leg without the traditional limitations.
"The main limitation of neurostimulation has always been that body position – for example, sitting up or lying down – often resulted in significant changes: either a decrease or increase in the intensity of the stimulation as the spinal cord moves further and closer from the site of stimulation with patient movement," says Dr. Shaparin.
The Medtronic AdaptiveStim, however, senses the patient's position and adjusts stimulation accordingly. According to George Mandybur, MD, neurosurgeon with the Mayfield Clinic for Brain & Spine in Cincinnati, Ohio, the device incorporates an accelerometer similar to the motion sensor technology used in smart phones and computer gaming systems.
"It frees patients from continually making manual adjustments to stimulation levels as they move about during the day," says Dr. Mandybur. "The advantage of the new sensor stimulator over previous stimulators is that it will 'learn' how to adapt to the individual’s positioning."
Incorporating it into your practice
In late 2011, following the FDA's approval of the Medtronic device, Dr. Mandybur implanted a new spinal cord stimulator for treating chronic pain in a patient suffering from reflex sympathetic dystrophy.
"Implanting the RestoreSensor is exactly the same as implanting its technological predecessors," he says. "There is no change in the surgical techniques, and there is no increased risk to the patient."
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