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A Primer on Neurostimulation Device Systems for Clinicians and Practice Administrators


As an intervention for chronic pain, particularly in the back or legs, neurostimulation can be an effective frontline, alternative or adjunct treatment. Historically, neurostimulation has been used when other therapies that have failed to manage pain. However, recent advancements in design and reductions in cost have made this treatment much more practical. For today’s practitioner, neurostimulation therapy is an effective alternative for cases where systemic pain medications are ineffective or create undesirable side effects. 


How Neurostimulation Systems Work


Neurostimulation devices delivers pulses of low-level electrical current through a lead. The lead is typically attached to an optimal point in the patient’s nerve network. The low-level current interferes with pain signals on the neural pathways. Efficacy is achieved when pain signals are inhibited before they reach the brain. As a result, patients report experiencing pain relief.


Potential neurostimulation benefits:


  • Long-term pain relief
  • Increased perfusion in the extremities
  • Improved quality of life
  • Less invasive and more cost-effective treatment than many surgical interventions
  • Pain management alternative to systemic opioid-based pharmaceuticals
  • Adjunctive therapy for patients in acute withdrawal from opioid-based substances


Discrete Elements within Neurostimulation Systems


  • Neurostimulator - Rechargeable or non-rechargeable power source that generates electrical pulses which are regulated by the control system at the clinician’s direction.
  • Lead - A set of shielded wires with electrodes.  In percutaneous systems, the electrodes may be small implantable needles.  In implantable surgical systems, the lead may be a paddle. The electrodes transmit the electrical pulses to the stimulation site.
  • Control system – The portion on or attached to the device that allows the clinician to make changes to the device’s operation.  In most cases, to increase or decrease the level of electrical current put out by the neurostimulator.


Other uses:


Neurostimulation has been used to treat many conditions, including peripheral arterial disease (PAD).  In patients with PAD, the electrical impulses from the stimulator have been shown to improve circulation in the legs, resulting in improved mobility and pain reduction.  Neurostimulation therapy has also been used to reduce the frequency of epileptic seizures. In many cases, patients and their families prefer this treatment to antiepileptic medications, which create an undesirable level of sedation.  In addition, there are several investigational uses being researched for neurostimulation.  For instance, because neurostimulation can trigger the release of catecholamines, it may be useful in relieving asthma attacks. Treatments for anxiety, craving, stroke, tinnitus, and traumatic brain injury based on neurostimulation practices are also being studied.


Whether for its efficacy or for its popularity with patients, medical practices should consider offering neurostimulation therapy.  For certain device systems, application is relatively easy to perform and training requirements and costs are modest.  In many cases, medical centers will be able to develop a neurostimulation practice within a few months.

  


 


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