Sometimes nerves can become irritated or damaged, and this can result in neuropathic pain (nerve pain). Neuromodulation is an interventional pain treatment which can be effective for neuropathic pain. A wire is inserted in a particular area and an electrical current is applied via a battery. You will feel the electrical current as a tingling, tapping or buzzing sensation in the area. It is hoped this stimulation will alter your experience of pain. Not everyone gets pain relief from neuromodulation. It is sometimes important to have a trial of neuromodulation before having a permanent system implanted, and Dr Cornish will discuss this pathway with you at consultation. This allows you and your doctor to assess whether this treatment is suitable for you.
What does the procedure involve? Temporary stimulation leads (wires) are implanted either under the skin, or in the epidural space within your spinal column. There will be a dressing over the skin where the wires leave your body. The wires are attached to an external battery which is fastened to the skin with dressings. It is very important not to get any of the dressings wet during the trial period, which usually lasts for 7-10 days.
What will happen during the procedure? A couple of weeks before the trial, you will meet with the practice nurse. During this meeting you will receive education about the device, the perioperative process and what to expect during the trial. The company representatives will also be present on the day the leads are inserted in theatre, and either they or the practice nurse will program the stimulator for you postoperatively and during the trial period. On the day the leads are inserted you will be admitted to hospital and the nurses will prepare you for theatre. You will meet the anaesthetist who will prepare you for the procedure. Because this procedure requires x-ray guidance it cannot be performed if you are pregnant. If you are, or think you may be pregnant, please contact our office as soon as possible.
What happens after the procedure? After the leads are inserted, you will be taken back to the recovery room and then to your room to rest. Our practice nurse will see you in recovery or in your room postoperatively and program the neuromodulation unit. You will stay in hospital overnight, and your doctor will see you prior to discharge. A physiotherapist will also visit you and give you a range of gentle exercises for the weeks after surgery. A follow up appointment will be arranged for you at Specialised Pain Medicine approximately 4 days postoperatively for a dressing check and reprogramming. At the end of the trial period (7-10 days), you will return to our office and our nurse will remove the neuromodulation leads while you are having a consultation with your doctor. At that point the doctor will discuss the results of the trial with you and plan your ongoing treatment.
What are the possible complications? This procedure has a very low risk of complication, but there are some that you should be aware of. local discomfort: Some patients may experience some discomfort in the area where the leads were inserted for a few hours or days. Some patients may also have a mild skin reaction to the tape used to secure the bandages (this is the most common complication for a trial of neuromodulation). Lead migration: sometimes the leads can move or may fall out during the trial period. If this happens, contact our office immediately. It is important to be very gentle with the leads and bandaging so as not to dislodge them. Post dural puncture headache: with epidural leads, occasionally patients may develop a headache which is worse when standing up. This type of headache is uncommon, but can happen if the needle pierces the dura (inside membrane of the epidural space). Please contact our office if you develop a headache after the procedure. Bleeding or infection: (peripheral leads ) - please contact our office immediately if you develop fever, discharge or pain around the lead site. (epidural leads ) - please contact our office immediately if you develop a fever, worsening back pain and/or weakness in your legs after the procedure. If these symptoms occur outside of office hours, you should attend the nearest emergency department.