Neuromodulation
This covers a variety of treatments
TENS
The least invasive form of neuromodulation is transcutaneous electrical nerve stimulation (TENS). This is most commonly seen during labour but is also popular in the treatment of back pain.
TENS is widely used elsewhere in the world. There are an estimated 450,000 users annually in Canadian state hospitals, for example, while in Scandinavia TENS is well known as a treatment for period pain. A small electrical device delivers electrical impulses across the skin. The device is usually about the size of a personal stereo. The device is connected by wires to sticky pad electrodes, which are placed on the skin in the area of the pain. This allows a small, low-intensity electric charge to be passed across the area. TENS is thought to work in two ways:
  • By selectively stimulating certain 'non-pain' nerve fibres to send signals to the brain that block other nerve signals carrying pain messages
  • By stimulating the production of endorphins, natural pain-relieving hormones
The device is usually used for 15 to 20 minutes, several times a day, and is controlled by the user rather than a health professional. Pain relief may be rapid and last for days.
Unlike many pain-relieving drugs, TENS isn't addictive and seems to have few side-effects, it does however seem to have a ceiling effect.
Acupuncture
Like TENS acupuncture is almost harmless. The only real risks associated with it are pneumothorax. Acupuncture has been in use for tens of thousands of years in China, South America and parts of Europe. It almost certainly acts again via endorphins and oxytocin, and also by breaking up motor end plates in muscle. It is particularly useful in myofascial pain but can also be used effectively for IBS, migraine and sciatica amongst others. Western acupuncture incorporated the best of traditional Chinese acupuncture and the diagnostic scientific background of modern medicine. In the UK, this is promoted by the British Medical Acupuncture Society an organisation of which I am proud to be a member.
Trigger point injection
When pain is not responsive to the above it sometimes responds to an injection: this is administered almost always into localised trigger points. Sometimes it is appropriate to use local anaesthetic agents alone, sometimes steroid and sometimes Botox. These techniques are most commonly used for myofascial pain.
Implantables
The final step in neuromodulation is implantable devices. These place electrodes alongside nerves to reduce the painful impulse. They work by either switching off pain nerves or by stimulating nerves that down-regulate the pain-carrying fibres. They are only suitable for a limited number of patients as most respond to less invasive procedures. Information concerning this can be found here.
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