What is neuromodulation?
The principle of pain reduction in neuromodulation is based on a reduction in the conduction of pain impulses. What all neuromodulation techniques have in common is that the reduction in pain impulse conduction is caused by the targeted application of electrical interference impulses. In addition to the type of electrical energy used, the various neuromodulation techniques differ in the frequency of energy delivery.
Spinal cord stimulation - our speciality at a glance
- Spinal cord stimulation has been a proven and guideline-compliant therapy for chronic pain for many years. Most of our SCS patients suffer from persistent back and leg pain following previous back surgery.
- Electrodes placed on the spinal cord are connected to a small current generator and reduce the transmission of pain in the pain pathway of the spinal cord. This enables us to halve the pain in 70 % of our patients.
- An active life is possible again when using the appropriate devices.
Video on neuromodulation
Pain regulation at the touch of a button: how does spinal cord stimulation work?
An SCS system consists of a small, barely visible pulse generator implanted under the skin and special contact wires. These contact wires, also known as electrodes, lie on the spinal cord and thus on the pain pathway. Electrical interference signals generated by the SCS pulse generator cause a reduction in the rate of pain impulses that are transmitted from the spinal cord to the brain. The patient controls his "pain pacemaker" with a wireless remote control and thus regains control over his pain. While a reduction in pain signals used to be associated with a tingling sensation in the former area of pain, this phenomenon no longer occurs with the latest generation of devices.
Spinal cord stimulation - why with us?
There are more than 350,000 patients worldwide who have been successfully treated with SCS (spinal cord stimulation). In Germany, around 2,500 patients are currently treated with an SCS system every year. However, there is an estimated need for approx. 10,000 - 12,000 "pain pacemakers". The reasons for this underuse, apart from the costs, are the lack of knowledge of many doctors about this form of therapy.
What you can expect from us:
- A wealth of experience thanks to up to 150 operations per year
- Neuromodulation since 1993
- Manufacturer-independent device recommendation depending on patient needs
- Regular aftercare
Dr Gall performs well over 150 operations per year. As head of the "Intraoperative Neuromonitoring" working group at the Neurosurgery Clinic at the University of Munich's Großhadern Hospital, he was already dealing with issues relating to "current" in neurosurgery in the early 1990s. This experience helps to reduce potential risks and complications.
The various neuromodulatory procedures can be differentiated by the frequency of current application:
1) Single application of electrical energy: thermodenervation / radiofrequency ablation
Further information on the Thermodeervation
2) Intermittent current application: TENS
In transcutaneous electro-neurostimulation (TENS), current is applied to the area of pain 1 - 2 times a day for 10 - 15 minutes using reusable adhesive electrodes. The adhesive electrodes are applied to the skin over the area of pain and should cover a main area of pain about the size of the palm of the hand. The power source is a small hand-held device that the patient operates themselves. The treatment is painless. The costs are usually covered by health insurance. We support our patients in choosing the right device and train them in how to use it correctly
3) Continuous application of electrical energy: Spinal cord stimulation (Spinal cord stimulation)
A system consisting of a pulse generator, similar to a pacemaker, with an associated electrode is implanted into the body under the skin. This ensures the continuous delivery of electrical energy to the pain pathways of the spinal cord.
Infections and wound healing disorders are extremely rare. Theoretically, impairments of nerve and spinal cord function are conceivable and have been described in the specialist literature. In everyday clinical practice, however, they are an absolute rarity. Our chosen technique of implanting electrodes under local anaesthetic helps to identify undesirable side effects at an early stage and treat them accordingly. In this way, negative long-term consequences can be avoided.
Over the last 10 years, SCS systems have undergone far-reaching technical development. This progress has made it possible to select "nerve pacemakers" specifically according to the patient's needs. The basis for this is a manufacturer-independent selection of implants. At the Schmerzwerkstatt München, we co-operate closely with various manufacturers. However, we are and remain independent and utilise this for individual therapy concepts.
As spinal cord stimulation is a recognised therapy for the treatment of chronic pain, all costs are covered by health insurance companies. We take care of the necessary correspondence with the insurance companies in individual cases. Our dual expertise in neurosurgery and specialised pain therapy facilitates communication with your insurance company.
To optimise the treatment outcome, we generally opt for a two-stage procedure for SCS implantations. In the first step, the electrode is placed on the spinal cord via a small puncture during a hospital stay of just under a week under local anaesthetic.
In the following "test phase", the pulse generator is worn on the skin in a belt. All our patients test the SCS system over several days in the clinic. Only our patients decide how to proceed on the basis of their subjective pain reduction.
For patients who report at least a 30 per cent reduction in pain after just a few days in the test phase, the final pulse generator is implanted under the skin after a further 3 weeks. This second procedure takes about 20 minutes and can be performed under local or general anaesthetic, depending on the patient's preference. One to two overnight stays in the clinic are planned for this.
Even with a "nerve pacemaker", complete freedom from pain is not a realistic treatment goal in most cases. We are interested in an honest improvement in quality of life with individually varying pain reduction.
50 % of our patients report a pain reduction of 82 % after using the device. Around 70 % of patients experience relief of 50 %. In some cases it is possible to stop the medication completely, in others the dose can be reduced.
You decide whether to activate the neurostimulator yourself using the remote control. You can stop the application at any time and switch off the device without any consequences.
The first neuromodulation procedures were developed 40 years ago. If therapy is not successful despite long-term medication or multiple operations, pain pacemaker implantation is a real alternative for patients with chronic pain who want to regain their quality of life. The method is suitable for selected pain in the thoracic, lumbar and cervical spine (BWS/LWS/HWS). The localisation of the pain is less important. The cause of the pain is decisive for the success of spinal cord stimulation therapy. A significant reduction in pain can be expected, especially in the case of nerve pain.
Indications for neurostimulation:
- Failed back surgery syndrome: persistent pain after back surgery, for example after a herniated disc or fusion
- Zoster neuralgia (persistent nerve pain after previous shingles)
- Permanent nerve pain in the arms or legs (Sudeck's disease or CRPS)
- Pain caused by narrowing of the blood vessels (peripheral arterial occlusive disease)
- Pain with angina pectoris or after a mastectomy
A nerve pacemaker cannot be implanted in all pain patients. Certain allergies or rare mental illnesses are possible contraindications. If you have any questions, we will be happy to help.
A pain pacemaker can be a way to significantly reduce pain, especially in patients who have previously undergone spinal surgery. In this case, there are various systems to choose from. Instead of the battery-operated models with a service life of 3-5 years, the latest generation of rechargeable pulse generators have a service life of 8-12 years. However, the patient must regularly recharge the batteries of these latter systems. The aim of our consultation is to select a system that meets the individual needs of our patients. In all cases, the statutory or private health insurance provider is the cost bearer. We will be happy to advise you on the details.
In the Pain workshop Munich we favour devices with the longest possible service life in order to reduce the number of further interventions. By way of comparison, non-rechargeable battery systems need to be replaced after just 3-5 years. In contrast, the service life of rechargeable battery-powered systems is up to 12 years.
However, this is offset by the weekly charging process, which takes 45 - 60 minutes. Specialised X-ray examinations are also possible with the latest generation of SCS systems. Even a magnetic resonance imaging examination can be carried out with an integrated nerve pacemaker.
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