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Neuromodulating Procedures

Epidural Spinal Cord Stimulation
Percutaneous or paddle electrodes are placed in certain portions of the spinal canal with the patient under partial or general anaesthesia. The low-level electrical current stimulates structures in the spinal cord, producing pleasant tingling sensations in the painful body areas, masking the painful ones. The patient can adjust the intensity of the stimulation using a hand-controlled device as needed.

Subcutaneous Stimulation
Percutaneous electrodes can be placed directly under the skin, for example, for local treatment of chronic back pain or certain types of headaches. In the latter case, the lead is placed over the occipital nerves at the back of the head. By this method, the need for medications with significant side effects such as opioids (e.g., morphine) can be substantially reduced or even eliminated.

Deep Brain Stimulation
In some chronic neuropathic pain syndromes, electrodes may be implanted in the brain. In this technique, precisely defined brain regions are stimulated. The stimulator setting can be adjusted at any time after the surgery as needed.

Implanted Pump System
When chronic pain is resistant to all other treatment methods, an implanted pump system may be an option. Highly effective medications are administered in small doses directly into the spinal fluid. The flow rate is determined and can be adjusted as needed by the physician using an external programming device. In certain cases, the patient can self-administer supplementary doses by means of a hand-controlled device.

A prerequisite for all of these therapies is a thorough interdisciplinary evaluation and a trial of less invasive, multimodal treatment. The definitive implantation is undertaken if adequate pain relief and significant improvement of function are achieved during a test phase of sufficient length.