From the Guidelines
A neurostimulator pain device is an implantable medical device that delivers mild electrical impulses to specific nerves or areas of the spinal cord to interrupt pain signals before they reach the brain. This technology is typically recommended for patients with chronic pain who haven't responded adequately to more conservative treatments like medications, physical therapy, or injections 1. The system consists of thin wires (leads) with electrodes that are placed near the nerves or spinal cord, and a small pulse generator (similar to a pacemaker) implanted under the skin, usually in the abdomen or buttock area.
Key Components of Neurostimulator Pain Devices
- Thin wires (leads) with electrodes
- Small pulse generator implanted under the skin
- External programmer for patient control Patients control their stimulation using an external programmer that allows them to adjust settings within physician-prescribed limits. Common types include spinal cord stimulators, dorsal root ganglion stimulators, and peripheral nerve stimulators.
Procedure for Implantation
Before permanent implantation, patients typically undergo a trial period of 5-7 days with temporary leads to determine effectiveness, as noted in guidelines for managing pain during the COVID-19 pandemic 1. The device works by creating a pleasant tingling sensation (paresthesia) that masks pain signals or by using sub-perception stimulation that patients don't feel but still blocks pain. This approach is based on the gate control theory of pain, which suggests that non-painful inputs can close the "gates" to painful inputs, preventing pain sensation from traveling to the central nervous system.
Considerations for Use
The use of neurostimulator pain devices should be considered on a case-by-case basis, taking into account the individual patient's needs and circumstances, including the potential risks and benefits of the device, as well as alternative treatment options 1.
From the Research
Definition of Neurostimulator Pain Device
A neurostimulator pain device is a type of medical device used to treat chronic pain by delivering electrical impulses to specific nerves or areas of the body.
Types of Neurostimulator Pain Devices
- Spinal Cord Stimulation (SCS) devices, which deliver electrical impulses to the spinal cord 2, 3, 4
- Peripheral Nerve Stimulation (PNS) devices, which deliver electrical impulses to peripheral nerves 3, 5
- Deep Brain Stimulation (DBS) devices, which deliver electrical impulses to specific areas of the brain 2
- Transcutaneous Electrical Nerve Stimulation (TENS) devices, which deliver electrical impulses through the skin to underlying nerves 2, 3
Mechanism of Action
The exact mechanism of action of neurostimulator pain devices is not fully understood, but it is thought to involve the modulation of pain signals in the nervous system 2.
Effectiveness
Studies have shown that neurostimulator pain devices can be effective in reducing chronic pain in some patients 3, 4, 5. For example, a systematic review of SCS found that it had positive effects on pain in nine out of 15 studies 3. Another study found that PNS was effective in reducing pain in patients with peripheral neuropathic pain 5.
Safety
Neurostimulator pain devices are generally considered safe, but they can cause adverse events such as hemodynamic instability, inadequate pain control, and extended recovery times 6.