What is neuromodulation?
Neuromodulation is a general word that refers to activity within the human nervous system. Neuromodulation for treating pain refers to the use of highly specialized technology that can alter the function of the human nervous system.
For example, electrical stimulation may be introduced to various parts of the body, either through the skin (called transcutaneous electrical nerve stimulation, or TENS) or into deeper areas of the body using needles or surgically implanted devices called spinal cord stimulators. Drugs can be delivered through implanted devices called
"drug pumps."
Which providers treat pain using neuromodulation?
Neuromodulation is an exciting and growing field within the specialty of pain medicine. While TENS has been around for a long time, newer technologies such as the drug pumps, peripheral and spinal cord stimulators and devices to deliver electrical stimulation to the human brain are much newer. Doctors using these devices to treat pain require extensive training and are generally board-certified anesthesiologists or neurological surgeons.
Is neuromodulation appropriate for my pain condition?
With the exception of TENS, neuromodulation is often considered a "last resort" treatment after less expensive, more conservative therapies have failed. That view is changing as we learn more about the technology and treatment outcomes and we train more physicians in this highly specialized area.
A patient's access to the newer technologies may be limited, often because of payment issues. Most people without insurance cannot afford to pay for such treatments on their own and
some insurance companies may refuse to pay for this treatment. Happily, this is changing but insurance carriers, including worker's compensation,
often try to exclude expensive treatments such as neuromodulation. The office
staff of the pain-trained physicians who use these technologies, working with
the medical equipment companies, may have success in persuading insurance
carriers to cover the treatment if it is medically appropriate for the specific
patient.
For more information about these technologies and the physicians who offer them, see the sections below.
Transcutaneous Electrical Nerve Stimulation (TENS):
Transcutaneous electrical nerve stimulation has been available as a clinical tool for many years. It was introduced in the United States more than 30 years ago and has widespread use, in particular, for acutely painful conditions including muscular injuries.
TENS is a common treatment in physical therapy clinics. There is little evidence that one type of transcutaneous
electrical nerve stimulation unit reduces pain better than another and there are
numerous stimulators on the market. Information about its use for various types of pain
can be found in numerous areas on this website. On the left side of every page
is a search box - type in
"TENS" and click the "search" button for links to these areas.
Spinal Cord and Peripheral Nerve Stimulation/Implantable Drug Pumps:
For an excellent discussion on this topic see the following articles on this website.
Other information may be found both on this website and others:
Deep Brain Stimulation and Motor Cortex Stimulation:
Deep brain stimulation has been used for the treatment of some neurological conditions such as Parkinson's Disease. More recently, it has also been used for the treatment of some painful conditions. Treatment in these areas are limited to just a few academic centers in the United States and are considered
"experimental" by most insurance companies. For more information on these technologies, check the following links:
Finding Help:
Information about physicians and centers that use this technology, along with tips about choosing medical providers can be found on this website and elsewhere at
