Cycling, gardening, playing with the children: With the help of neuromodulation, popularly known as a „pain accelerator,“ it is hoped that what has long been denied chronic back pain patients will once again be possible. We are specialized in this topic – especially in patients who have undergone multiple surgeries on their spinal column.
Neuromodulation as an alternative for chronic back pain
What is neuromodulation?
Spinal cord stimulation – our special field at a glance
- Spinal cord stimulation is a therapy that has been proven effective and recommended for chronic pain for years. Most of our SCS patients suffer from persistent back and leg pain after previous spinal surgeries.
- Electrodes placed on the spinal cord are connected to a small current generator and reduce the pain conduction in the pain pathway of the spinal cord. This results in a halving of the pain in 70 of % our patients.
- With the use of the appropriate devices, active life is again possible.
Video about neuromodulation
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More informationPain regulation at the touch of a button: How does spinal cord stimulation work?
A SCS system consists of a small implanted under the skin and barely visible pulse generator and special contact wires. These contact wires, also known as electrodes, lie on the spinal cord and thus the pain pathway. Electrical interference signals generated by the SCS generator cause a reduction in the rate of pain impulses that are transmitted to the brain via the spinal cord. The patient controls his „pain pacemaker“ using a wireless remote control, thereby regaining control over his pain. In the past, a reduction in the pain signals was associated with a tingling sensation in the former pain area; this phenomenon no longer occurs with devices of the latest generation.
Spinal cord stimulation – why with us?
Worldwide, there are more than 350,000 patients who have been successfully treated with SCS (Spinal Cord Stimulation). In Germany, currently approximately 2,500 patients are being treated with an SCS system per year. However, there is an estimated need of approximately 10,000–12,000 „pain management devices“. The reasons for this under-supply lie not only in the costs, but also in the lack of knowledge among many doctors about this therapy form.
What you can expect from us:
- Extensive experience thanks to up to 150 operations per year
- Neuromodulation since 1993
- device recommendation independent of the manufacturer, depending on the patient's needs
- regular follow-up care
The different neuromodulatory procedures
The various neuromodulatory procedures can be distinguished by the frequency of the electrical current applied:
1) one-time application of electrical energy: thermodestructive ablation / radiofrequency ablation
Further information about thermodenservation
2) Intermittent current application: TENS
With transcutaneous electrical neuro stimulation (TENS), the current is applied to the pain area 1–2 times per day for 10–15 minutes using reusable adhesive electrodes. The adhesive electrodes are applied to the skin over the pain area and are intended to cover an area of about the size of a hand. The current source is a small handheld device that the patient operates themselves. The treatment is painless. The costs are usually covered by the health insurance. We support our patients in choosing the right device and train them in proper handling.
3) Continuous application of electrical energy: Spinal cord stimulation (English:Spinal Cord Stimulation)
A system of an impulse generator, similar to a pacemaker, with an associated electrode is implanted into the body under the skin. This ensures the continuous delivery of electrical energy to the pain pathways of the spinal cord.
Risks and side effects
Infections and wound healing disorders are extremely rare. Theoretically, impairment of nerve and spinal cord function is conceivable and described in the literature. In clinical practice, however, they are among the absolute rarities. The technique we have chosen for the implantation of electrodes under local anesthesia helps to detect undesirable side effects early and treat them accordingly. This way, negative long-term consequences can be avoided.
Independence from manufacturers
In the last 10 years, a profound technical development of the SCS systems has taken place. This progress has opened up the possibility of selecting „neural stimulators“ specifically according to the needs of the patients. The basis is an industry-independent selection of the implants. In the Schmerzwerkstatt München we cooperate closely with various manufacturers. However, we remain independent and use this for individual therapy concepts.
Reimbursement by the health insurance company
Since spinal cord stimulation is a recognized therapeutic method for the treatment of chronic pain, all costs are covered by the health insurance companies. We handle the necessary correspondence with the payers in individual cases. Our dual expertise in neurosurgery and specialized pain therapy facilitates communication with your insurance company.
Process of implantation: Test phase provides certainty
For an optimal treatment outcome, we usually employ a two-step procedure for SCS implantations. In the first step, the electrode is placed in local anesthesia over a small puncture into the spinal cord during a hospital stay of just under a week.
In the following „test phase“, the pulse generator is worn on a belt on the skin. All our patients test the SCS system over several days in the clinic. Only our patients decide on the further course of action based on subjective pain reduction.
In patients who report at least a 30 percent reduction in pain after just a few days in the trial phase, the final trigger is implanted under the skin after another 3 weeks. This second procedure takes about 20 minutes and can be performed under local anesthesia or general anesthesia, depending on the patient’s wishes. One to two nights in the clinic are provided for this purpose.
Regular follow-up care for sustainable therapeutic success
We take meticulous aftercare seriously. New life situations of our patients also change the power requirements. Here, occasional adjustments are necessary. Furthermore, every technical device should be checked from time to time for its full functionality. Therefore, all our patients are invited to a consultation appointment every 3 months. Here, a technician from the manufacturer checks all functions. This is followed by the clinical control of the SCS system by its operator. Only in this way can the initial therapeutic success be guaranteed permanently. In case of urgent questions, we are of course available to our patients at all times.
Treatment results: Pain relief % possible by 82%
Even with a „nerve stimulator,“ complete pain freedom is in most cases not a realistic treatment goal. Our goal is to achieve an honest improvement in quality of life, with individual differences in pain reduction.
50 % of our patients report a reduction in pain of 82 after the device is implanted %. Approximately 70 % of the patients experience a reduction of 50 %. In some cases, complete discontinuation of the medications is possible, in others a reduction in the dose.
You decide yourself via the remote control whether to activate the neurostimulator. You can stop the application at any time and turn off the device without leaving a trace.
When is a pain pacemaker useful?
The first methods of neuromodulation were developed 40 years ago. In cases where therapy fails despite continuous medication or multiple surgeries, implanting a pain pacemaker is a real alternative for patients with chronic pain who want to regain their quality of life. This method is suitable for selected types of pain in the chest, lower back, and cervical spine (BWS/LWS/HWS). The location of the pain is less important here. What is crucial for the success of spinal cord stimulation therapy is the cause of the pain. A significant reduction in pain is particularly expected in nerve pain.
Indications for neurostimulation:
- Failed back surgery syndrome: persistent pain after back surgeries, such as after a herniated disc or a spinal fusion
- Zoster neuralgia (persistent nerve pain after previous shingles infection)
- lasting nerve pain in the arms or legs (Morbus Sudeck or CRPS)
- pain caused by lack of blood flow in narrowed blood vessels (peripheral arterial occlusive disease)
- Pain with angina pectoris or after a mastectomy
Not all pain patients can have a nerve stimulator implanted. Certain allergies or rare mental illnesses are among the possible contraindications. We are happy to help with any questions.
Which system is best suited?
Especially in patients with pre-operated spinal columns, a pain pacemaker can be a way to achieve significant pain reduction. In this case, several systems are available. Instead of battery-powered models with a lifespan of 3-5 years, rechargeable pulse generators of the latest generation have a lifespan of 8-12 years. However, the batteries in these latter systems must be charged regularly by the patient. The goal of our consultation is to select a system that meets the individual needs of our patients. In all cases, the statutory or private health insurance provider is responsible for the costs. We are happy to advise you on the details.
How do you live with a pain pacemaker?
At Schmerzwerkstatt München, we prefer devices with a maximum lifespan to reduce the number of further procedures. A comparison: With non-rechargeable battery systems, a replacement is necessary after 3-5 years. The lifespan of rechargeable systems with an internal battery is, however, up to 12 years.
However, this is in contrast to the weekly charging process, which takes 45–60 minutes. Special X-ray examinations are also possible with the latest generation SCS systems. Even a nuclear magnetic resonance examination can be performed with an implanted pacemaker.
Dr. Gall performs far more than 150 procedures per year. As head of the „Intraoperative Neuromonitoring“ working group in the Neurosurgical Clinic at the University of Munich’s Klinikum Großhadern, he was already involved in the early 1990s in questions surrounding the topic of „current“ in neurosurgery. This experience helps to reduce potential risks and complications.