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NEUROMODULATION
According to the International Neuromodulation Society, neuromodulation is the alteration of nerve activity through targeted delivery of a stimulus, electrical or chemical.  Applications in use today include electrical nerve stimulation, intrathecal drug delivery, transcranial magnetic stimulation, deep brain stimulation, etc.

In terms of interventional chronic pain therapies using neuromodulation, implanted  spinal cord stimulators (SCS) and intrathecal drug delivery pumps (IDDP), are the most commonly utilized devices.  The decision of which device to use will play a large part in the patient's therapeutic success.  However, with advances in SCS outpacing those in IDDP therapies , intrathecal therapies have seemingly been reserved for stimulation failures.    

In a study by Mekhail et al, a predictive formula was devised to predict analgesic success with SCS.  A value x is obtained from x=(-0.064*age)+(-0.743*1 if male, 0 if female)+(0.486*1 if clinically depressed, 0 if not clinically depressed)+(0.681*1 if neuropathic pain exists, 0 if absent)+(0.468*1 if post-laminectomy syndrome exists, 0 if none)+(-0.678*1 if spine-related pain exists, 0 if none).  Once x is calculated, it is entered into p, where p is the probability of success with SCS. P=e^x/(1+e^x), where e is Euler's number (2.718).  Anyone with a value higher than 0.880 has a higher probability of success with a SCS than with IDDP therapy. 

Mekhail N, Mehanny DS, Armanyous S, et al. Choice of spinal cord stimulation versus targeted drug delivery in the management of chronic pain: a predictive formula for outcomes [published online ahead of print, 2020 Jan 12]. Reg Anesth Pain Med. 2020;rapm-2019-100859. doi:10.1136/rapm-2019-100859.​
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  • ABOUT
  • INTERVENTIONS
    • EPIDURAL INJECTIONS >
      • CAUDAL EPIDURAL INJECTIONS
      • INTERLAMINAR EPIDURAL INJECTIONS >
        • CERVICAL INTERLAMINAR EPIDURAL INJECTIONS
        • THORACIC INTERLAMINAR EPIDURAL INJECTIONS
        • LUMBAR INTERLAMINAR EPIDURAL INJECTIONS
      • TRANSFORAMINAL EPIDURAL INJECTIONS
    • JOINT & BURSA INJECTIONS >
      • SYNOVIAL FLUID ANALYSIS
      • Hip Injection
      • Knee Injection
      • Sacroiliac Joint Injection
      • TROCHANTERIC BURSA INJECTION
    • KYPHOPLASTY
    • LUMBAR DECOMPRESSION >
      • LUMBAR DECOMPRESSION
      • MINIMALLY INVASIVE LUMBAR DECOMPRESSION (MILD)
    • MUSCLE & TENDON INJECTIONS >
      • CARPAL TUNNEL INJECTION
      • PLANTAR FASCIA Injection
      • TRIGGER POINT INJECTION
    • NERVE BLOCKS >
      • CLUNEAL NERVE BLOCKS
      • SYMPATHETIC BLOCKS >
        • CELIAC PLEXUS BLOCK
        • GASSERIAN GANGLION BLOCK
        • LUMBAR SYMPATHETIC BLOCK
        • SPHENOPALANTINE GANGLION BLOCK
        • STELLATE GANGLION BLOCK
    • NEUROMODULATION >
      • INTRATHECAL DRUG DELIVERY PUMP
      • NERVE STIMULATION
    • RADIOFREQUENCY ABLATION
    • REGENERATIVE PROCEDURES
    • SACROILIAC JOINT FUSION
  • PHARMACEUTICALS
    • ANTIDEPRESSANTS
    • ANTICONVULSANTS
    • Clinical Drug Monitoring
    • LAXATIVES
    • Interventional Pharamacology >
      • RADIOGRAPHIC CONTRAST AGENTS
      • LOCAL ANESTHETICS
      • CORTICOSTEROIDS
      • TOPICAL ANTISEPTICS
    • Intravenous Infusion Therapy
    • MUSCLE RELAXANTS >
      • DANTROLENE
  • CONDITIONS
    • Ankylosing spondylitis
    • CROHN'S DISEASE
    • COMPLEX REGIONAL PAIN SYNDROME
    • Fibromyalgia
    • Headache >
      • Cluster Headache
      • Migraine Headache
      • Other Headache
      • Tension-Type Headache
    • Insomnia
    • Myofascial Trigger Points
    • OSTEOMYELITIS
    • Pancreatitis
    • Plantar Fasciitis
    • Poststroke
    • RHEUMATOID ARTHRITIS
    • Sickle Cell Disease
    • Systemic Lupus Erythematosus
  • SYMPTOMS
    • Abdominal Pain
    • PELVIC PAIN
  • MISCELLANEOUS
    • CODES: CPT and ICD
    • Hormone Testing
    • JOKES
    • PERIOPERATIVE CONSIDERATIONS