Neuromodulation
What is Neuromodulation?
Neuromodulation therapy is a treatment that uses an electrical signal to help block and depress pain signals that are sent to your brain. This is done by placing a small pacemaker-like device under your skin connected to wires that send electrical signals to your brain. Before placing a permanent device, most patients undergo a one week trial period with a temporary device to see how well the stimulation works. If there is pain relief, a permanent implant is placed. This treatment does not fix the source of pain, but reduces the intensity of the pain that you feel.
Indications
Neuromodulation may be a good option for you if you
Have chronic back pain that has lasted at least 3-6 months
Have not gotten relief from physical therapy, mediations, or injections
Do not have a condition that requires surgery
Have been evaluated and cleared by your care team.
What to expect
Step 1: Trial Period
Before a permanent device is placed, you will undergo a trial that typically lasts 5-10 days.
During the trial
Thin temporary leads are placed through a needle near your spinal cord (similar to an epidural injection).
The leads are connected to a small external device you wear on a belt.
Go about your normal routine to see how well the stimulation controls your pain.
The trial is considered successful if you experience at least a 50% reduction in pain and improvement in daily function. If the trial is successful, you and your doctor will discuss moving forward with a permanent implant.
Step 2: Permanent Implant
If the trial is successful, the permanent procedure is done as an outpatient surgery under light sedation or general anesthesia. It usually takes about 1 to 2 hours to place the leads and the generator.
Post Procedure
It is normal to have some soreness or mild swelling at the incision site. These symptoms are temporary and should go away in a few days.
Activity Guidelines
The most important goal in the first several weeks is to allow the leads to settle into place and prevent lead migration. Your doctor will give you specific guidelines, but in general:
First 6-8 weeks after implant:
Avoid bending, twisting, or stretching your trunk excessively
Do not raise your arms above your head
Do not lift anything heavier than 5-10 pounds (about a gallon of milk)
Avoid vigorous exercise, running, or high-impact activities
Walking is encouraged - begin with short, gentle walks and increase intensity as tolerated
After 6-8 weeks (once cleared by your doctor):
You may gradually return to normal activities
Follow any rehabilitation or exercise programs recommended by your doctor or physical therapist.
You will have a follow up appointment about 1 week after the appointment to help you program the device. You will then be able to control the electrical signal using a hand held remote.
When to call your doctor
Contact your doctor if you experience any of the following after the procedure
Fever or chills
Severe or worsening pain
New weakness or numbness in your arms or legs
Difficulty with bowel or bladder control
Redness, swelling, or drainage at the injection site
Severe headache
Sudden change in stimulation pattern
Frequently Asked Questions
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It is important to clarify with your doctor whether or not it is safe to drive home after this procedure.
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Trial placements typically take 30-60 minutes. Permanent placements can take longer, depending on the device and the patient.
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Recovery is usually minimal. If you proceed with permanent implantation, most patients return to light activity in a few days under the guidance of their doctor.
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Yes. If the device is not working well it can be removed.
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Many newer neuromodulaation devices are MRI compatible, but always inform your healthcare provider that you have a spinal cord stimulator before having any imaging or procedures.
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Yes. Most systems come with a handheld remote or app that allows you to adjust intensity. Your doctor will help you learn how to use your device.