Neuromodulation: The Time Is Now

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

Then/Now

• 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!