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Neuromodulation involves implanting electrical devices in the body to treat chronic pain.

Before a device is implanted, our patients undergo a trial of Neuromodulation lasting 2 weeks. We implant the device only if our patient has experienced a significant reduction in their pain.

Electrodes are implanted in the spinal cord (Epidural space) modulating specific pathways in the spinal cord and blocking transmission of pain signals to the brain by complex mechanisms. These treatments are well established for certain types of severe chronic pain, such as Failed Back Surgery Syndrome (FBSS) and Complex Regional Pain Syndrome (CRPS), both of which have approval by the NICE guidelines (TA159).

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Procedure

Spinal cord stimulators - SCS

Spinal cord stimulator leads are placed in the epidural space. The epidural space runs from your neck along the length of your spine. It contains the nerves that connect your spine to your upper and lower body. The leads are placed into the epidural space through a needle. The doctor will also use an x-ray machine to help guide him. This is done under sedation.

Peripheral nerve stimulators - PNS

Peripheral nerve stimulators are placed in the periphery along the peripheral nerves that are affected. The Pain consultant will discuss these aspects with you at length. This procedure will be carried out by your Pain doctor and a PNI (peripheral nerve injury unit) surgeon.

Your doctor will discuss with you what you should and should not be doing, and when it is safe for you to start with activities such as swimming or exercise classes. We would suggest that you gradually start gentle exercise such as walking. This will help you to build up your strength again. It is important to restrict any sudden jerky movements of the spine (for SCS) and limbs (for PNS) during the trial and during the first 6 to 8 weeks after an implant to prevent migration of the leads. This would possibly allow for it to be set in its position to optimise benefits.

It is an implant that is an electrical machine that can change some of the pain messages that your body is sending to your brain, and reduce the amount of pain that you are experiencing. The stimulator works by sending very small amounts of electricity to parts of the spinal cord. You will feel this as slight tingling over the area that is usually painful.

As with any such procedure there is a small possibility of nerve injury (temporary or permanent). Paralysis is very uncommon (with approximate chance of 1 – 2 patients per million). Other serious but also very rare complications include bleeding, infection (1-5%) or allergic reactions. Every effort is made to avoid these serious complications by using a sterile technique as well as the use of X ray during the procedure.

Other less serious complications include the small chance of the leads moving (migrating), there may be a failure in capturing the area of pain, inadequate pain relief or unpleasant sensation. Some people do not find that SCS helps their pain.

Your doctor will carefully and clearly explain all rare and not so rare complications associated with spinal cord stimulation and peripheral nerve stimulation.

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