If oral medications and other strategies have not sufficiently relieved neuropathic pain, and surgery has been ruled out, implantable pain management systems may be an option.

See Pain Management for Chronic Back Pain

Three therapies—spinal cord stimulation, peripheral nerve stimulation, and pain pumps—reduce pain without extensive surgery. Each therapy is provided on a trial basis first. After the trial period, the person decides whether to use the therapy over the long term.

See Options in Spinal Cord Stimulation

Implantable pain management does not work for everyone, but when it is successful, people experience significant advances in daily functioning.

See Understanding Neuropathy Symptoms

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Spinal Cord Stimulation and Peripheral Nerve Stimulation to Ease Pain

Spinal cord stimulation therapy and peripheral nerve field stimulation are related types of electrical stimulation that treat chronic pain. Mild electrical pulses are directed to disrupt pain messages to the brain, reducing the feeling of pain.

See Spinal Cord Stimulation for Chronic Back and Neck Pain

To begin spinal cord stimulation, thin insulated wires called leads are equipped with electrical contacts and inserted into the space surrounding the spinal cord. In peripheral nerve field therapy, the leads are placed just under the skin. In both types of stimulation, a small implanted generator sends the electrical pulses and is attached by a wire to the leads. (During the trial period, an exterior generator is used.)

See Spinal Cord Stimulation: The Trial Period

The patient is awakened during implantation surgery to provide feedback on where the pulses should be directed to relieve pain. Some patients have both spinal cord stimulation and peripheral nerve field therapy at the same time.

See Spinal Cord Stimulation: The Trial Period

Stimulation therapy does not eliminate all the pain, but pain is reduced by at least half for the majority of patients, leading to a major improvement in daily activities.4

See Advantages of Spinal Cord Stimulation

Disadvantages and Risks
Device-related problems are fairly common, and there is a small risk of infection. Serious complications, such as a hemorrhage or neurological damage—including paralysis—are rare.

See Disadvantages and Risks of Spinal Cord Stimulation

The other drawback is that spinal cord stimulation does not relieve pain for everyone who uses it. About 50% to 60% of people using a low-frequency system and 80% or more of those using a newer high-frequency system achieve major relief.5,6

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Intrathecal Pain Pump

Medication is delivered directly to the spinal cord when an intrathecal pain pump is implanted. Sending medication to the pain receptors near the spine interrupts pain signals to the brain, easing the perception of pain.

To begin the procedure, the person is placed under local or general anesthesia. A thin tube, or catheter, is inserted into the fluid-filled area around the spinal cord known as the intrathecal space. A small pump is implanted in the front of the body, usually in the abdomen, and the pump and catheter are attached.

See Invasive Pain Management Techniques

Medication is injected into a reservoir in the pump by the doctor, then sent by the pump through the catheter. Morphine (brand names MS Contin, Kadian, and others) is one medication often administered with a pain pump. The doctor fills the reservoir with medication during implantation, and then refills it about once a month through an injection in the doctor’s office. Pumps can be programmed to suit individual preferences on timing of the prescribed medication. The option for round-the-clock medication is a major advantage of the pain pump.

Watch: Intrathecal Pump Implant Video

More than one medication can be added to the pump, if needed. This could include an opioid (also called a narcotic) another pain medication, or a local anesthetic to treat neuropathic pain. The opioids morphine, ziconotide, and baclofen are approved by the U.S. Food and Drug Administration for continuous delivery, but other medications are also used.

See Narcotic Pain Medications

By targeting delivery of the medication, a much lower dose can be used, reducing side effects. While pain pumps cannot eliminate pain entirely, they may offer significant pain relief that leads to improved day-to-day functioning. Many people are able to reduce their reliance on other medications when they use a pain pump.

As with spinal cord stimulation and peripheral nerve field therapy, the individual undergoes a trial period before using the therapy long term. The pain pump can be removed at any time.

Disadvantages and Risks
Reactions to medications are the most common complication with pain pumps, followed by problems with the catheter used. Less common risks include, but are not limited to, infections, spinal damage, development of a granuloma—an inflammation of tissue—at the end of the catheter, and death.

Implantable pain relief can be considered for those in severe pain who have not had success with medications and other treatments.

References:

  1. Verrills P, Sinclair C, Barnard A. A review of spinal cord stimulation systems for chronic pain. J Pain Res. 2016;9:481-92.] Many people using spinal cord stimulation are able to reduce or stop taking opioid pain medications.
  2. Kapural L, Yu C, Doust MW, et al. Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial. Anesthesiology. 2015;123(4):851-60.
  3. Deer TR, Skaribas IM, Haider N, et al. Effectiveness of cervical spinal cord stimulation for the management of chronic pain. Neuromodulation. 2014;17(3):265-71.
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