Neuromodulation: An Introduction

While neuromodulation was once considered an exotic form of therapy, it has become part of the mainstream of care that we are turning to it many times a month to help patients that were previously considered untreatable.



Neuromodulation is a fancy term, which is applied to a variety of techniques, which attempt to modulate or change (read here control) the function of a group of nerves. The two main categories of neuromodulation are chemical and electrical. Both main techniques seek to increase efficacy and specificity by targeting a relatively small number of nerves. This is done by means of the precise placement of the catheter that delivers the medicine or the wires that carry the electrical energy.

Chemical neuromodulation, hereafter referred to more simply as pumps, usually involves placing a catheter (a tiny hollow tube) somewhere within the spine. The exact placement of the catheter tip as well as the medication delivered will determine the conditions that can be treated as well as the likelihood of side effects.

Electrical neuromodulation, again hereafter referred to more simply as stims, involves the placement of one or more wires in the vicinity of a neural target. The target may be in the brain (deep brain stimulation), the spinal cord (spinal cord stimulation or SCS for short), in the area of the nerve roots either intracolumnar or extracolumnar, in the area of a large peripheral nerve (peripheral nerve stimulation) or in a painful area served by a group of smaller nerves (peripheral field stimulation).

The choice of a particular technique requires considerable experience and skill. Often more than one type of neurmodulation is possible and the choice involves balancing the potentialities, the side effects as well as the convenience factors associated with each of the techniques. We at Schlesinger Pain Centers are one of the largest implanters of neuromodulation devices in Southern California.

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