At Barolat Neurosciences in Denver, we are here to provide our patients with leading care and expertise in the use of neuromodulation for the treatment of chronic debilitating pain. We also are here to provide answers to frequently asked, common questions.In regards to pain, when should a person consider neurostimulation surgery for pain treatment?
When a person has had debilitating pain for more than 6 months despite many other treatments, then one can be considered for neurostimulation surgery. These other treatments may include physical therapy, medications, spine surgery, cortisone injections, transcutaneous nerve stimulation and acupuncture.
What other testing has to be done to be a candidate for neurostimulation procedures?
Most insurance companies and neurostimulation pain professionals require a screening psychological exam to rule out any serious psychological issues that could interfere with the success of the procedure. The majority of people who suffer from chronic pain have experienced depression, frustration, and anger. The goal of the psychological evaluation is to make sure that these issues are not of such a magnitude to jeopardize the outcome of the neurostimulation procedure. Of course we also want to make sure that there are no significant psychiatric disorders or cognitive issues that would nullify the efficacy of the modality.
How do we know it will work?
A patient will undergo a 7-10 day trial with a temporary stimulator inserted. This will be powered by an outside generator source. If the patient experiences a good response, which we consider greater than 50 % reduction in pain, then a permanent stimulator lead or electrode with an IPG (implantable pulse generator) are implanted for permanent use. The reports of satisfactory pain relief vary from 40-80% success rates. What determines the success is highly variable from patient to patient. That is the reason for a trial to be performed first.
How big is the IPG (device) or battery unit?
The smallest IPG is about the size of 3 silver dollars stacked on top of each other.
How long does the battery last and how do you replace it?
The batteries are rechargeable through the skin and may last 5-7 years, depending on the power demand for that patient's stimulation requirements. To replace the battery is a minor outpatient procedure performed under local anesthetic and sedation. That procedure takes about 30 minutes.
How do I control the stimulator?
You may have 2-5 different stimulator programs to choose from. In addition the intensity of the stimulation is controlled by the patient with a remote control device. The different programs give you flexibility to change the stimulation patterns based on your areas of pain. For example, some patients do not require their legs to be stimulated at night, so they shut that region off at night.
What are the limitations of having a stimulator implanted in my body?
There are limitations to having an implantable generator. These limitations include the inability to obtain MRI's, or therapeutic ultrasound. Your physical activities may be restricted from contact sports. Patients have downhill skied and returned to running after stimulator implantation. Again, you must remember if there a significant problem or the stimulator is not effective any longer, it can always be removed.