Neuroaugmentation is an invasive pain management technique incorporating various methods of electrical stimulation (e.g. of spinal cord and peripheral nerve) methods and implantable drug delivery systems to function. This procedure is highly effective and can be used to localize and help diagnose the source of pain. It allows concentrating medication at the source of the problem to reduce inflammation, swelling and pain with fewer side effects than oral medications.
What is Electrical Stimulation?
Electrical stimulation is a technique that uses low-voltage electrical current for pain relief.
It is done under local anesthesia, intravenous sedation and fluoroscopic guidance. The desired area is approached with the help of a specific needle (depending on the prefernce of your medical expert). A stimulating lead is advanced in the desired area and stimulated electrically. When patient reports some degree of pain relief, the electrode is stitched to the skin and connected to an external pulse generator. Mostly, the patient is allowed to go back home after 24 hours of the procedure. After few days the electrode is removed. Few antibiotics are also suggested during the course of the treatment.
Effect can be rightly felt during the course of the procedure. About 75-90% of the patients report a significant relief after 3-4 days of electrical stimulation. The method is temporary and can be repeated if required.
What is an Implantable Drug Delivery System?
Unlike oral medications that must be absorbed systemically and cross the blood-brain barrier to reach pain signals, targeted drug delivery interrupts pain pathways at their source in the cerebrospinal fluid and spinal cord.
Implantable drug delivery systems (IDDS) are an example of such systems available for pain and palliative care. An implanted, programmable pump and catheter releases prescribed amounts of pain medication directly into the intrathecal space.
Intrathecal drug delivery enables patients to experience pain relief using a fraction of an oral medication dose, which can help to minimize the uncomfortable and sometimes intolerable side effects (e.g., drowsiness, dizziness, nausea, vomiting and constipation) that often accompany pain medication taken orally. It also provides pain relief in patients who cannot achieve adequate analgesia even with high doses of oral opioid medications.
How is IDDS used?
The implanted pump and catheter release prescribed amounts of pain relieving medication in close proximity to receptor sites and ion channels located in the dorsal horn of the spinal cord.
Intrathecal drug delivery is particularly effective because pain medication is released directly into the cerebrospinal fluid (CSF), with only minimal drug levels circulating in the bloodstream. As a result, effective pain relief may be achieved using much smaller doses than are used in orally administered analgesics, which may lead to fewer or more tolerable systemic side effects.
Results: Benefits of treating chronic intractable pain with implantable drug delivery include effective pain relief with reduction or eliminated use of oral pain medicines. It has a reduced side effects ratio compared to oral medication and is cost effective. With a quick rehabilitation, IDDS is more patient satisfying.
Are Neuroaugmentation and Implantable Drug Delivery Systems best option for me?
Every treatment has its own set of risks and benefits. An invasive method is always indicated when the patient does not recover with oral medications, physiotherapy and life style changes. Before settling for any pain management technique, consult your medical expert.