Oral opioid medications – or narcotics – have been widely used to treat all types of pain for any duration. Unfortunately, these prescribing practices have fueled the current opioid epidemic. Over the past several years, studies have proven that these medications are highly addictive and do not improve daily function for patients experiencing chronic pain. In fact, long-term daily use of opioids makes it less likely that patients will return to work or stay productive in their lives.
Opioid addiction is difficult to see in yourself. At first, taking these medications is a choice. Over time, the medications affect your brain in ways that produce a powerful urge to continue use. This can include a feeling of pain reduction that is caused by the “high” that your brain receives. Anyone is susceptible to opioid addiction.
Additionally, side effects from opioids affect many body systems, creating problems such as fatigue and exhaustion, constipation, reduced motivation and self-confidence, depression and anxiety, an inability to concentrate, weakened immune system, liver disease, respiratory infections, osteoporosis and fractures, anemia, opioid induced hyperalgesia (increased sensitivity to painful stimuli caused by opioid use) and respiratory depression – which can be deadly. The safety risks and healthcare costs caused by opioid addiction is extremely high. In fact, opioid-related emergency room visits, overdoses and deaths now outnumber motor vehicle injuries.
At Center for Pain Medicine, we strive to help patients find alternatives to opioid use. For example, Neuromodulation Therapy is an excellent option for patients with persistent and refractory back or extremity pain. These therapies release patients from oral pain medication and can completely eliminate pain, freeing patients to live life fully.
What is Neuromodulation Therapy?
Neuromodulation therapies utilize implanted medical device technology to interrupt or modify pain signals, originating from the spinal area, before they’re interpreted by the brain. These devices are implanted under the skin in a discrete area of the back. Implanted catheters or leads connect the device to the appropriate location within the epidural space of the spine. All areas of the unit are concealed.
Neuromodulation therapies provide greater pain control, as compared to oral pain medication, and eliminate common opioid side effects such as constipation, drowsiness, and mental cloudiness. Patients also have the power to control their system with the ability to increase the strength, or amplitude, of pain reduction or turn the device on or off (with spinal cord stimulator). Additionally, office visits are reduced to 2-3 per year, versus every few weeks for opioid monitoring.
Spinal Cord Stimulators
Spinal cord stimulators include an implanted battery unit attached to leads placed in the appropriate level of the epidural space. Mild electrical impulses stimulate pain fibers and the new impulse reaches the brain before the pain signal arrives. Pain is blocked and patients may feel a tingling or massaging sensation often reported as comforting.
The remote device allows patients to customize the area and strength of stimulation, meaning patients have the power to control whether the sensation targets, for example, your upper right arm or lower left leg. Additionally, certain smart devices automatically adjust as you move, providing the right amount of stimulation based on your previous settings for that position.
Intrathecal Drug Delivery Systems
Intrathecal drug delivery systems, or pain pumps, deliver a very small amount of pain medication directly to the intrathecal space, or area of fluid around the spinal cord. This allows a low medication dose to be delivered precisely to pain receptors, often eliminating the need for oral pain medication. Like spinal cord stimulators, a pump device connected to a catheter is discreetly implanted in the back. Advanced technology now allows patients with implantable devices to undergo Magnetic Resonance Imaging (MRI) as needed.
Each patient works closely with their doctor to adjust medication delivery to the appropriate level of pain relief. Pumps are refilled at office visits at predetermined intervals. With extremely low medication doses, patients are completely free from drug side effects and can lead active lifestyles.
Dorsal Root Ganglion (DRG) stimulator
Dorsal root ganglion stimulator is a novel technology for treatment of complex regional pain syndrome (CRPS) or chronic neuropathic pain in the lower limb including pelvic, groin, hip,knee and foot pain. Traditional spinal cord stimulation does not always provide adequate relief in patients with complex regional pain syndrome or focal neuropathic pain. DRG stimulation is a more specific and targeted therapy for the affected body part. DRG stimulation interrupts pain signals before they reach the spinal cord or brain.
Peripheral Nerve Stimulator
Peripheral Nerve Stimulator is a cutting edge therapy designed to relieve pain caused by a damaged peripheral nerve, including intercostal, dorsal scapular, and ilioinguinal nerves, resulting in chest wall pain, back pain, or pelvic pain. The wireless peripheral nerve stimulator is the smallest implanted stimulator system, introduced through a needle under X-ray or ultrasound guidance. The external wearable antenna transmits power wirelessly to the stimulator.
Which Option is Right for You?
While radicular pain, or pain that travels from an injured area of the spine to the arms or legs, is best controlled by a spinal cord stimulator, back pain can be treated with either an intrathecal drug delivery system or a spinal cord stimulator. Candidates for neuromodulation included patients suffering from nerve pain – such as persistent neuropathic pain, Failed Back Surgery, and Complex Regional Pain Syndrome.
Prior to implantation of either neuromodulation device, the physician will administer a test to help patients determine whether neuromodulation therapy is the right choice. Although these therapies are often effective long-term solutions, the process can be reversed upon request. If you are a candidate for neuromodulation therapy, your physician will provide detailed information and guidance to help you make the right decision for your condition.