Implantable pain therapies: Neurostimulation
Treatments for persistent pain can involve many types of therapies such as medication, physiotherapy, and psychological therapy. In some patients these treatments may not work or cause unpleasant effects. For these patients neurostimulation can be an option. This is a therapy which directs electricity on to the nerves. This requires surgery to put a device under the skin that makes electricity (a neurostimulator). Connected to this are leads that are put on the nerves involved in the pain. The device is turned on and electricity is transmitted to the nerves involved in feeling pain. This may give pain relief by hiding the pain with a numbing or tickling feeling.
The most high quality, up-to-date research says:
- There is moderate evidence that spinal cord stimulation (SCS) relieves pain within 5 years in persistent pain conditions, including complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS).
- There is low level evidence that SCS improves function and quality of life in 5-10 years.
- For all other types of neurostimulation there is insufficient evidence that it works.
There are also possible harms that can happen with neurostimulation. These include bleeding into the brain, nausea, headache or migraine and a small risk of death. Problems related to the device or the operation such as infection or mechanical problems can also occur. Sometimes another operation is needed to fix problems. This is known as a revision. Studies have found that revision operations have been needed in 12-38% of patients shortly after their first SCS operation.