Neurol. praxi. 2019;20(6):433-438

Neuromodulation techniques in the management of vertebrogenic pain syndromes

MUDr. Róbert Rapčan, PhD., MBA, FIPP¹, doc. MUDr. Igor Martuliak, PhD., MPH², MUDr. Jan Lejčko³, MUDr. Róbert Illéš, PhD., MPH⁴, MUDr. Michal Krajčovič⁴, MUDr. Ladislav Kočan, PhD.⁵

¹ EuroPainClinics, Bardejov

² Algeziologická klinika SZU, FNsP F. D. Roosevelta, Banská Bystrica

³ Centrum pro léčbu bolesti ARK, FN Plzeň

⁴ Neurochirurgické oddelenie, Nemocnica svätého Michala, a. s., Bratislava

⁵ Klinika anestéziológie a intenzívnej medicíny, Východoslovenský ústav srdcových a cievnych chorôb, a. s., Košice

Neuromodulation techniques represent a spectrum of therapeutic approaches with various options to influence the pain pathways.
It can be either the application of the chosen medication or the action of electrical signals in the vicinity of the peripheral
(PNS) or central nervous system (CNS), by which the perception of pain is modulated. The application of medications into the
epidural or subdural space is commonly used as a part of catheterisation techniques with a continuous administration of the
chosen medication. The second group is made up of modern neurostimulation systems, during which electrical signals at the
level of the PNS or CNS affect the conduction and perception of pain in a complex manner. Despite numerous theories based on
experimental results, their pathophysiological mechanism of action has not yet been fully explained. The dominant role among
neurostimulation techniques in the management of chronic pain, for example in the cases of complex regional pain syndrome
(CRPS), failed back surgery syndrome (FBSS) and others, belongs to the techniques based on the stimulation of spinal structures,
dorsal ganglia and peripheral nerves, with the application of electrodes to the posterior and anterior epidural space. The types of spinal stimulators differ mainly in the application of different frequencies within the stimulation parameters settings and the
electrical impulse generator type used. Nowadays, a distinguishing parameter is also the compatibility of the systems with magnetic
resonance. Neuromodulation techniques are important part of chronic refractory pain treatment. Correct indications of patients
with a functional spinal cord stimulation lead to improvement of quality of life and reduction of pharmacological side effects.
The goal of this article is to cover current neuromodulation treatment modalities and to inform about actual clinical outcomes
of various methods.

Keywords: neuromodulation, spinal cord stimulation, intrathecal pump

Published: December 1, 2019  Show citation