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Neuromodulation as Treatment for Chronic Pain


By Nick Rhoades, APN and JI Li, MD, Applied Pain Institute

Chronic pain, defined as any pain lasting more than three months, is a leading cause of disability in the United States. There are many treatments available for chronic pain, including acupuncture, yoga, physical therapy, cognitive behavioral therapy, injections, and medications to name a few. If these treatments are not providing significant relief or are associated with bothersome side effects, using electrical stimulation to modulate pain signals, sometimes referred to as neuromodulation, is a potential option. Spinal cord stimulators (SCS) and dorsal root ganglion (DRG) stimulators are two types of neuromodulation.

Using neuromodulation as treatment for chronic nerve pain has been around since ancient times. The first documented attempt was in the early Common Era, through the placement of an electric eel to the skin. Since then, there have been tremendous advancements in the technical and medical industries, leading to the first implantation of SCS in 1981 and the first DRG stimulator implantation in 2016.

SCS and DRG stimulators are a very safe and effective treatment for chronic neuropathic pain. SCS are used to target pain in the neck, back, and upper and lower extremities, caused by conditions such as failed back surgery syndrome, sciatica, complex regional pain syndrome (CRPS), various neuropathies, peripheral vascular disease, shingles, and other causes of neuropathic pain. DRG stimulators are used to target more specific areas of pain, caused by Complex Regional Pain Syndrome (CRPS), post-surgical lower abdominal, pelvic, groin, hip, knee and ankle pain, vaginal and testicular pain, and shingle pain.

What are SCS and DRG stimulators and how do they work?
Our nervous system is responsible for the communication of pain signals, which largely involves the spinal cord for transportation of these signals to the brain. SCS and DRG stimulation can help interrupt the transmission of these pain signals through the conduction of electric stimulation along the spinal cord, reducing the amount of pain experienced by patients. Furthermore, SCS and DRG stimulation has been shown to reduce inflammation within the nervous system.

The biggest differences between SCS and DRG stimulators are where the electrodes are placed in the spine and how they target pain. The SCS electrodes are placed vertically along the back of the spinal cord (see figure 1), while DRG electrodes are placed horizontally along nerve roots called dorsal root ganglions as they exit from the spinal cord (see figure 2). These are where the nerve cells and fibers are located. Because of the location of these electrodes, the SCS provides a large coverage of pain treatment, while the DRG provides a more targeted treatment.

How safe and effective are SCS and DRG stimulators?  
There have been multiple studies over the years that have demonstrated significant safety and effectiveness of SCS and DRG stimulators. Both SCS and DRG stimulators require trials before final implantation. During the trials, patients must achieve 50 percent or more pain relief, notable improvement of daily activity and sleep patterns, and/or reduction of pain medications. The trials and implantations are done under anesthesia and are completed as outpatient procedures. Most patients can return to work and normal life in several weeks after the final implantation. There may be a low risk of temporary surgical pain, swelling, infection, bleeding, as well as a small chance of lead migration. Most insurances, including Medicare, will cover SCS and DRG treatment.

If you are suffering from chronic pain, a pain management specialist will help you understand the cause of your pain, provide a comprehensive assessment of all treatment options, and determine if you are a good candidate for SCS or DRG treatment.

To learn more about pain management procedures, contact Applied Pain Institute at 309-662-0088 to set up a consultation. Dr Li and his medical team have many years of successful experience managing all pain syndromes including SCS and DRG treatment.