Neuromodulation has become an important alternative treatment option in refractory chronic neuropathic pain syndromes. The field of neuromodulation has advanced over the years. Now you can give patients:
- Multiple frequencies up to 10,000 hertz
- Different kinds of patterns of stimulations, like burst stimulation
- Dorsal root ganglion stimulation
- Patients who had multiple back surgeries, or injections, or physical therapy were offered opioids, initially short-acting and then long-acting. Now, if a patient has had those things and the pain is not getting better, rather than subjecting that patient to a high dose of opioids, I think it’s better to offer neuromodulation therapy earlier
- If the patient was on a high dose of opioids and it was still not working, then we offered neuromodulation therapy
- With the advancement of the neuromodulation therapy, and the clinical data available, and the fact that high-dose opioids in long-term chronic patients doesn’t help those patients much, I think this it’s time to bring back an algorithm and offer the patients a neuromodulation therapy early.
So, what should practitioners know? Bottom line: Offer neuromodulation therapy earlier!