Chronic pain refers to pain that lasts longer than three to six months, even if the original cause or injury is no longer present. The brain and nervous system ‘learn’ to keep producing pain signals, even when these signals are no longer helpful.
Conditions causing chronic pain are very common. This study explains that: “Globally, 10% of adults are diagnosed with chronic pain conditions each year.”
Treatments are constantly being developed to help tackle the problem. Neurostimulation has been used since the 1960s to treat chronic pain but has grown in popularity recently. So what is it? Let’s find out more.
What is Neurostimulation Therapy?
Neurostimulation therapy is a treatment that targets the nervous system and attempts to block pain signals using low-voltage electrical impulses.
A 2019 study on neurostimulation for chronic pain describes it as: “the application of electricity to the dorsal columns of the spinal cord to modulate/manipulate the pain signals carried by the ascending pain pathways to the brain.”
The main types of neurostimulation used for chronic pain are spinal cord stimulation (SCS), dorsal root ganglia (DRG) stimulation and peripheral nerve stimulation (PNS).
SCS targets the spinal cord directly. DRG stimulates bundles of nerves in part of the spinal cord. PNS stimulates peripheral nerves which are the part of your nervous system outside of your brain and spinal cord.
There are several other types of neurostimulation therapy including:
- Deep brain stimulation: (DBS): Using electrical impulses directly into specific areas of the brain.
- Repetitive transcranial magnetic stimulation (rTMS): A non-invasive stimulation using an electromagnetic coil placed against the patient’s scalp.
- Vagus nerve stimulation (VNS): An implantable device using electrical impulses to stimulate the vagus nerve which runs from the brain, through the neck, chest, and stomach.
We will focus on SCS, DRG, and PNS in this article since they’re the most commonly used types.
How Does Neurostimulation Therapy Work for Chronic Pain?
Neurostimulation works by sending safe, low-dose electrical pulses to the nervous system which block pain signals from being sent to the patient’s brain. The pulses are either sent to the spinal cord or the peripheral nerves.
If you’ve ever used a transcutaneous electrical nerve stimulation (TENS) machine which uses electrical impulses externally, it’s a similar concept to that but internally.
This type of treatment works on the gate control theory of pain. This sounds complicated but just means that the nerves in your spine or other areas of your nervous system act like a ‘gate’ for pain. They open the ‘gate’ to let the pain signals through to reach the brain, so you feel pain.
In theory, neurostimulation blocks these signals from getting through the ‘gate’. However, there are also other theories as to why neurostimulation works, and scientists don’t fully understand it all yet.
Often before having the full device implanted, doctors implant the wires and connect them to an external neurostimulation device so the patient can trial the treatment.
When it’s time for the full procedure, the neurostimulation device is implanted under the skin in the patient’s abdomen or buttock. Thin medical-grade wires connect the device to the patient’s spinal cord or specific peripheral nerves to deliver the electrical pulses. The wires are insulated and can also be referred to as electrodes or leads.
The procedure itself is usually done on an outpatient basis and has a low recovery time. The incision is small, and patients will usually be under local anaesthetic and sedated. This means the area will be numb and you won’t feel the procedure, but you won’t be asleep.
In some cases, the doctor will program the device and can control the settings when needed. In other cases, patients can control the system with an external, handheld device so they can get relief when they need it. Sometimes, patients can even connect their internal device to their smartphone and control it via an app!
This article from Brain Sciences explains that both the pulse (the strength of the electrical stimulation) and the frequency (how many pulses per second) can be changed to suit the patient’s needs.
The pulses themselves will be very low-voltage electricity and are often described as a tingling or buzzing feeling (referred to as paresthesia). This 2022 article explains: “Conventional SCS applied with pulse frequencies between ∼40 and 60 Hz evokes paresthesia (i.e., tingling or pins-and-needles sensations) in the area of the body targeted by stimulation.”
The British Pain Society explains that in some models, the device will have a battery that will last years, and then need to be replaced. In other cases, the device may need to be regularly recharged without being removed.
Neurostimulation therapy won’t work for everyone, but if it does, it can help to reduce pain levels markedly. If the device doesn’t work for you, it can be removed during an outpatient procedure.
A 2020 systematic review evaluated 12 studies on the use of neurostimulation for chronic pain. Of the 12, nine studies concluded that patients had significantly reduced pain levels, while in the other three studies, patients didn’t experience a marked reduction in pain.
Neurostimulation has the potential to provide long-term reduction of pain levels for chronic pain patients. A 2023 study of neurostimulation to treat chronic lower back pain (CLBP) collected data from 133 participants over the course of three years. The study found that: “83% of participants experienced clinically substantial improvements in pain, disability, or both.”
Chronic pain often leaves patients feeling powerless. When patients are able to control the device themselves, it can give a sense of empowerment and freedom that living with chronic pain so often takes away.
Research also shows that the treatment is cost-effective for medical providers and can even reduce the use of risky medications.
A 2022 review explains that neurostimulation therapies are: “non-addictive, reversible strategies for managing intractable chronic pain.” So, unlike other many other pain treatments, such as opioids, neurostimulation doesn’t come with a risk of addiction or medical dependence.
In fact, some patients find that neurostimulation works so well for them that they can gradually withdraw from opioid medication. A 2023 study of 133 chronic pain patients using neurostimulation found that after three years: “49% of participants who were using opioids at baseline had voluntarily discontinued use, compared with 26% and 39% at one and two years, respectively.” The study goes on to explain that patients also reduced or stopped the use of other pain medications including non-steroidal anti-inflammatory drugs (NSAIDs), simple analgesics, and muscle relaxants.
If you need to stop the neurostimulation treatment, there are no distressing withdrawal effects as with many pain medications.
When you live with chronic pain conditions, over time the brain ‘learns’ to keep producing pain. You may hear this referred to as neural plasticity, which means the brain and nervous system literally change to get better at causing pain! Thankfully, just as your brain can learn to produce these pain signals, it can also learn to stop producing them by retraining your brain away from chronic pain.
Evidence shows that one of the many benefits of neurostimulation therapy is that if used early enough it can interrupt your nervous system learning to produce pain! Based on this, research suggests that patients who may qualify for neurostimulation: “would benefit from implementing the therapy earlier in disease pathogenesis.”
Neurostimulation can be used alongside other pain treatments to reduce pain levels and improve the quality of life for pain patients. A 2023 systematic review of neurostimulation for chronic pain concluded that it can be a highly effective, long-term chronic pain treatment when used alongside other treatments.
In summary, potential benefits include:
- Reduced pain
- Reduced need for oral medications (including medications with harmful side effects like opioids)
- Ability to do more due to lower pain levels
- Improved quality of life
- Sense of control over pain
- Can be used alongside other treatments
- Easily removed if no longer needed/not effective
- No systemic side effects (meaning unlike medication, the treatment goes straight to the required area without affecting the rest of your body’s systems)
- Easily adjusted to suit changing pain levels and the patient’s needs
- Pain relief for patients who haven’t had success with other treatments
- Long-term relief from pain
- Prevention of neuroplastic changes that result in long-term pain
Risks and Side Effects
As with any treatment, there are potential risks and side effects. However, the surgery is relatively safe and you will usually go home the same day.
It’s important to note that neurostimulation aims to reduce pain, but it won’t cure pain or address the route cause. The British Pain Society states that: “Patients should be told that SCS (spinal cord stimulation) will probably only help part of their pain. Teams offering SCS must be able to deliver appropriate additional therapies including pain management programmes.”
Since the treatment doesn’t involve the use of drugs and doesn’t cause systemic side effects, the risks mainly revolve around the procedure and the functioning of the device.
- Adverse reaction to the material of the device
- Adverse reactions to the anaesthetic
- Malfunction of the device
- Movement or misplacement of the wires and device
- Leakage of fluid around the spinal cord
- Development of scar tissue around the wires
- Blood clots
- Neurological damage
Evidence shows that lead migration (meaning the wires move from the correct location) is the most common problem with neurostimulation therapy. If this happens, further surgery will be required to correct the problem.
If you have a neurostimulation device implanted, you might not be able to have an MRI due to the metal parts. This depends on the typel of device implanted among other factors.
Who Can Have Neurostimulation Therapy for Chronic Pain?
More detailed research on neurostimulation therapy for chronic pain but initial results have been promising. Doctors may try neurostimulation if chronic pain is severe and other treatments have failed.
Chronic pain conditions that may be treated with neurostimulation therapy include:
- Neuropathic pain
- Complex regional pain syndrome (CRPS)
- Failed back surgery syndrome (back pain persisting despite surgery to ‘fix’ the issue)
- Post-herpetic neuralgia
- Phantom limb pain
- Lower back pain
- Severe chronic pain where other treatments have failed
- Occipital neuralgia
- Chronic headaches or migraines
A 2020 systematic literature review on the topic concluded that: “Spinal cord stimulation (SCS) for chronic pain of the spine and lower extremities and for CRPS is well-supported by high-level evidence”
A 2022 study stated that spinal cord stimulation is: “primarily indicated for chronic neuropathic pain of the trunk or limbs which is refractory to conventional medical management”.
Patients will be screened to ensure the treatment is suitable for them before the device is implanted. If you struggle with addiction or have unmanageable mental illness, you may be unable to have the treatment.
Doctors will also rule out people who have other implanted devices; those who need regular MRIs; and patients who may be unable to operate the device once it’s implanted.
Other Treatment Options
If neurostimulation isn’t right for you, don’t worry – there are plenty of other pain management options to explore.
Treatment options include:
- Pain medications: These can be over-the-counter or prescription medications.
- Talking therapies: Therapies like Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help you deal with your pain.
- Manual therapies: Physiotherapy, hydrotherapy, massage therapy, and many more manual therapies can help to reduce pain and increase your range of movement.
- Exercise-based therapies: This type of therapy can help you learn to exercise in a way that works for you and your symptoms, which can improve mobility and reduce pain.
- Mindfulness-based therapies: Many chronic pain treatments use mindfulness practices to help reduce stress and manage pain.
- Pain clinics or pain management programmes: In-person pain clinics or pain management programs like Pathways Pain Relief can help you reduce your pain and reclaim your quality of life.
Could Neurostimulation Therapy Be Right for You?
Many pain patients find that neurostimulation can help to reduce their pain and improve functioning. If you have severe chronic pain and other treatments haven’t worked for you, neurostimulation therapy could be the next step.
It’s important to do some research and talk to your medical team to see whether neurostimulation is an option for you. They can determine what’s best for your individual needs.
- Deer TR, Jain S, Hunter C, Chakravarthy K., (2019), “Neurostimulation for Intractable Chronic Pain.” Brain Sci. 2019 Jan 24;9(2):23. doi: 10.3390/brainsci9020023. PMID: 30682776; PMCID: PMC6406470.
- Susan T. Lubejko, Robert D. Graham, Giulia Livrizzi, et al., (2022), “The role of endogenous opioid neuropeptides in neurostimulation-driven analgesia”. Front. Syst. Neurosci., 14 December 2022
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- The British Pain Society, (2009), “Spinal cord stimulation for the management of pain: recommendations for best clinical practice”.
- Mark Hofmeister MSc, Ally Memedovich BHSc, Sage Brown BSc, et al., (2020), “Effectiveness of Neurostimulation Technologies for the Management of Chronic Pain: A Systematic Review”. Neuromodulation: Technology at the Neural Interface, Volume 23, Issue 2, February 2020, Pages 150-157.
- Christopher Gilligan MD, Willem Volschenk MD, Marc Russo MD, et al., (2023), “Three-Year Durability of Restorative Neurostimulation Effectiveness in Patients With Chronic Low Back Pain and Multifidus Muscle Dysfunction”. Neuromodulation: Technology at the Neural Interface, Volume 26, Issue 1, January 2023, Pages 98-108.
- Shafik Boyaji, MD, Contributor, and Pritesh Topiwala, MD, (2020), “Pain and neuromodulation: What’s all the “buzz” about?” Harvard Health Blog, Harvard Medical School.
- Yilong Zheng, Christopher Weiyang Liu BSc, MBBS, MMed Anaesthesia, Diana Xin Hui Chan MBBS, MMed Anaesthesia, et al., (2023), “Neurostimulation for Chronic Pain: A Systematic Review of High-Quality Randomized Controlled Trials With Long-Term Follow-Up”. Neuromodulation: Technology at the Neural Interface, Volume 26, Issue 7, October 2023, Pages 1276-1294.
- Timothy R Deer, MD, Jay S Grider, DO, PhD, MBA, Tim J Lamer, MD, et al., (2020), “A Systematic Literature Review of Spine Neurostimulation Therapies for the Treatment of Pain”. Pain Medicine, Volume 21, Issue 7, July 2020, Pages 1421–1432.