Post has been updated to incorporate SCS implants
Couple of members have reminded the mod team about the often forgotten use of electro stimulation in the treatment of neuropathic pain(Thank you ;)).
(1)Scrambler or TENS therapy(Neuromodulation),
Interferes with pain signal transmission, by ''mixing'' a ''non-pain'' information into the nerve fibres.It’s simple, easy, relatively inexpensive, non-invasive, and easily testable on the individual patient. You put the electrodes on, move them around and you should be able to tell in three to five days whether it’s going to work at all or not for the patient. Some have equated it to getting the same ultimate end result as spinal cord stimulator, but without having to unroof the spinal cord, sew an electrode on and then have it permanently connect to an implantable pump. A typical session on a Scrambler lasts 30 to 45 minutes, with the device sending low doses of electricity through electrodes placed on the skin of painful areas. The device “scrambles” or re-boots nerves left frayed and over-sensitized by chronic pain.So - basically working on the GATE CONTROL THEORY you feed in artificial nerve impulses designed to confuse the nerves, scramble the pain information that they’re sending, and allow them to re-set.
Although the studies are promising, they’ve been small and haven’t made much of splash in the medical community or with all types of neuropathy. Personally, scrambler has never worked for me. I have tried it on/off over the years for my CRPS - a legacy from cancer.- to no effect. In terms of its use in EM.? With systemic EM, the chronicity of my allodynia , hyperalgesia, and erythema means i can not tolerate clothes , let alone electrodes.Whilst it may confuse the hyper excited nerves and scramble info ,it actually induces local inflammatory response- vasodilation and erythema.
(2) Spinal Cord Stimulation (Neuroaugmentation) ,
Has been utilized for over 30 years for the treatment of refractory chronic pain. In comparison to most other procedures for pain management where a specific receptor is known to be the target for a particular drug or the site of action of a certain injection is the accepted premise, how SCS is able to function is shrouded in speculation. The idea that stimulation to large fibers “closes the gate” in a part of the spinal cord which in turn prevents the small fibers (pain fibers) from accomplishing their intention to communicate pain is surmised by the “gate theory” and predominates the school of thought for those looking to explain how it works. While electrical stimulation therapies inspired by the Gate Control Theory (Melzack/Wall ,1965), have succeeded, it is still a source of debate and controversy as it predicts that all types of pain should be inhibited when they are not. It would stand to reason that both acute and chronic pain, as well as nocioceptive and neuropathic pain, could be effectively treated as long as large fibers were stimulated – that has not proven to be the case.
The classic goal of SCS is to produce a field of paresthesias (a tingling sensation) directly over the patient’s pain complaints by stimulating the relevant cord structures without stimulating the nearby nerve root. By producing these paresthesias OVER the area of pain, we can interfere with the transmission of pain to the brain.
Whilst neither are for me ,I do believe in neuroplasticity. Does neuromodulation or neuroaugmentation have a role in the management of EM pain? .
Interested to hear your experiences and views.
Wishing all EM'ers a 'comfortable' night
Dual System Spinal Cord Stimulation for Control of Intractable Pain in Primary Erythromelalgia: A Technical Case Report
Control of intractable pain in erythromelalgia by using spinal cord stimulation.
http://www.ncbi.nlm.nih.gov/pubmed/7963776212-Scrambler52patientRCT_July2011_JPSM.pdf (358 KB)