What is neuromodulation?
The aim of neuromodulatory pain therapy is to suppress the pain signals at the level of the spinal cord. This is achieved by means of implanted electrodes, which are placed in the spinal canal at the level of the spinal cord where the pain signals are processed. With special stimulation programs, electrical impulses can then be administered via these electrodes to counteract the nerve signals responsible for pain perception. During such stimulation, patients typically feel a subtle, pleasant tingling sensation (known as 'tingling paresthesia'), which may masks the pain.
What are the possible indications?
In principle, this therapy is suitable for patients with the following causes of pain:
- Pain after back surgery
- Complex regional pain syndrome (CRPS)
- Peripheral neuropathic pain
- Peripheral arterial occlusive disease
Prerequisites for treatment
Other prerequisites are that drug-based pain therapies are not sufficient or cause too many side effects. All eligible patients are evaluated on an interdisciplinary basis together with colleagues from neurosurgery, psychosomatics and pain medicine. We carry out this process (as well as the surgical procedures) in collaboration with the Department of Neurosurgery at the University Hospital of Zürich. If a patient qualifies for testing of such a therapy, a cost approval is applied for from the health insurance company to cover the costs.
Neuromodulation treatment procedure
In a first surgical procedure, the electrodes are placed in the spinal canal. This happens under X-ray control in the operating room with a local anesthesia and light sedation. Then a test stimulation is carried out with the aim of being able to cover the painful area as precisely as possible with the electrical impulses. We rely on the patient's feedback for this. They are briefly awakened from sedation for this purpose. The optimal position of the electrodes is then determined according to this feedback. The electrode wires are then led out through the skin and connected to an external battery. Patients usually stay in hospital overnight and are then discharged home for the so-called 'test phase'. This test phase lasts approximately 2 weeks. During this time, patients come to us regularly for wound checks, dressing changes and stimulation adjustments. If the stimulation is successful and the pain and quality of life are significantly improved, we decide together on the definitive implantation. This consists of a second short operation in which the electrode wires and the definitive battery are implanted under the skin. If, on the other hand, it becomes clear during the test phase that the therapy is not satisfactory, the electrodes are removed again in a short procedure under local anesthesia.
Possible side effects and complications
Possible side effects or complications include, for example
- Bleeding, which can lead to temporary or, in rare cases, permanent paralysis and make surgical relief necessary
- Electrode displacements
- Connection problems between the electrodes and the battery
- Battery faults
- Loss of effectiveness of the stimulation
- Infections
- Electrode or cable breakage
- Pain in the area where the battery is implanted