3 Pain Specialists on Newly Approved Neurostimulation Treatment
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."
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."
Related Articles on Pain Management:New Radiofrequency Ablation Procedure Performed in Texas
App Lets Physicians, Hernia Patients Assess Chronic Pain
5 Pain Management Physicians Discuss Promising New Pain Therapy Procedures
© Copyright ASC COMMUNICATIONS 2015. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
- Dr. Julie Servoss: A GI tech must-have
- GI society roundtable: Putting together the game plan for potential colonoscopy cuts
- 5 critical steps to developing an ASC risk management program
- Researchers reconstruct ancient virus to enhance gene therapy — 5 notes
- GI physician leader to know: Dr. Jacques Van Dam of USC's Keck School Medicine