Neurostimulation for neuropathic radicular pain

Neurostimulation is a surgical technique that consists of modulating the nerve impulse by means of an electrode implanted on different components of the central and peripheral nervous system (cerebral, medullary, radicular or peripheral nerve neurostimulation).

The stimulus provoked by the implanted electrode “blocks” the pain signal coming from the damaged neurological structure to the brain.

The most frequent neurostimulation for the treatment of chronic neuropathic pain due to spinal cord or radicular lesions is the neurostimulation of posterior cords at the spinal cord level.

How is the neurostimulation treatment process?

This technique is performed in the operating room under local anesthesia and sedation.

The process consists of two phases:

  • Test phase: the electrode is placed in the appropriate position to cover the painful area and the wires are externalized through the skin. Over a period of one to two weeks, the patient will evaluate the ability of the system to improve their pain. The patient perceives a pleasant tingling sensation (paresthesia) in the painful area.
  • Definitive implantation phase: once the test phase is completed (between one and two weeks), the definitive implantation phase is reached in which, once the beneficial effect of the therapy has been verified, the electrode is attached to the generator in the operating room and the generator is finally placed, under aseptic conditions, in an area under the skin, usually in the abdomen.
See also  Robotic brain surgery for epilepsy

What types of pain can be treated with neurostimulation?

Spinal cord neurostimulation is most commonly used for the treatment of low back and radicular pain (sciatica) following spinal surgery (this is what we call “failed back syndrome”).

Pain secondary to sensory nerve involvement following certain surgical procedures, such as inguinal hernia surgery, thoracic surgery, maxillofacial surgery or varicose vein surgery, can also be treated.

Other pain syndromes that can be treated with spinal and radicular neurostimulation are: amputation pain (so-called phantom limb syndrome), pain caused by complex regional syndrome, sympathetic-reflex dystrophy, angina pectoris or neuralgia.

Does neurostimulation hurt?

The surgical procedure, by means of which the neurostimulator is implanted, is performed under local anesthesia and sedation; the pain sensation felt by the patient during the procedure is minimal.

The stimulus generated by the neurostimulator and distributed throughout the painful area produces a pleasant tingling sensation. The result is a quick and painless postoperative period.

What should the patient expect from neurostimulation?

A substantial improvement in their quality of life. The goal of neurostimulation is for patients with chronic pain to achieve an improvement in pain.

What are the risks of neurostimulation? What side effects may arise in the days following the procedure?

It is a safe technique. However, every procedure has possible complications.

The most frequent side effect is local pain at the puncture site, although it is usually mild and transitory. The small incision and the passage of needles can cause small areas of subcutaneous hemorrhage. Less frequently, an epidural hematoma may occur, which may require surgical evacuation if it significantly compresses the spinal cord or nerve roots. In case of infection, it may be necessary to remove the system.

See also  Do you know the pathologies associated with the spine?

In general, the benefit obtained from this procedure is much greater than its possible complications, which are infrequent.