Neurostimulation for pain management Flashcards

1
Q

Spinal Cord Stimulation

A

Type

  • implantation of electrodes in epidural space
  • level of posterior columns in spinal cord

Complexity and Burden

  • Invasive
  • outpatient surgical procedure
  • mid level burden

Mechanism

  • modulation of pain signals at spinal cord level
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2
Q

Transcutaneous Electrical Stimulation (TENS)

A

Type

  • electrodes placed on painful region of skin

Complexity/burden

  • non invasive
  • low burden

MOA

  • mayeb for mixed pain syndromes
  • Gate theory
  • vibration closes gate for pain information at spinal cord level
  • supraspinal mechanism

Complications

  • patient response variable
  • skin irritation
  • avoid with pacemakers,
  • avoid near carotid sinusm epiglottis
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3
Q

Peripheral Nerve Stimulation (PNS)

A

Type

  • implantation of electrodes in subcutaneous tissue over peripheral nerve that innervates affected area

Complexity

  • invasive
  • outpatient procedure
  • intermediate burden

MOA

  • Used for occiptal neuralgia, headache, regional pain in abdomen, back, pelvis, cervical areas
  • impulse interruption by collision
  • gate control within spinal cord
  • inhibition of neuroma activity
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4
Q

Transcranial direct current stimulation

A

Type

  • placement of electrodes on scalp and forehead
  • creates electrical field between 2 electrodes

Complexity

  • non invasive, minimal burden

MOA

  • subthreshold modulation of neuronal resting membrane potential
  • change in NMDA receptor
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5
Q

Transcranial magnetic stimulation

A

Type

  • magnet placed on scalp to stimulate brain tissue

Burden

  • non invasive
  • painful
  • low burden

MOA

  • modulation of brain neuronal excitability
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6
Q

Deep brain stimulation

A

Type

  • leads placed in deep brain structuers

Complexity

  • Invasive
  • inpatient
  • high burden

MOA

  • modulates hypothalamus
  • thalamus
  • periaqueductal gray
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7
Q

Motor Cortex Stimulation

A

Type

  • Grid placed on motor cortex

Complexity

  • Invasive inpatient procedure
  • high burden

MOA

  • modulates activity of underlying cortex and connections to other brain areas. WTF?
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8
Q

Gate theory

A

non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from traveling to the central nervous system.

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