The International Neuromodulation Society defines therapeutic neuromodulation as “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation … to specific neurological sites in the body.”
Neuromodulation approaches range from non-invasive techniques such as transcranial magnetic stimulation to implanted devices, such as a spinal cord stimulation or a deep brain stimulation system. The most common neuromodulation treatment is spinal cord stimulation for chronic neuropathic pain.
While they are not a cure for an underlying condition, neuromodulation therapies provide an additional means of managing symptoms of chronic conditions.
Direct Stimulation of the Trigeminal Nerve Branches
For the patient with refractory craniofacial pain, implantable electrical nerve stimulators are becoming potentially viable options.
“The development of a minimally invasive implantable neuromodulation system targeting craniofacial nerves has the potential to help patients suffering from facial pain…” Dr. Ashwin Viswanathan of Houston, Texas’ Baylor College of Medicine said in a press release.
A clinical trial is currently underway to determine the efficacy of treatment with such a device, which is powered wirelessly thereby eliminating the need for extensive tunneling down the neck with connection to an implanted pulse generator system. The system being studied is a wirelessly powered neurostimulator for pain in the face or head (not for headaches or migraine). This technology includes an implanted stimulator with an embedded receiver. The energy source is a small, external, rechargeable transmitter, which is worn by the patient. The transmitter sends the therapy program and power through the skin to the receiver.
Motor Cortex Stimulation (MCS) and Deep Brain Stimulation (DBS)
These approaches involve direct stimulation of the brain via electrodes implanted on the surface of the dura (MCS) or deep within the brain (DBS.) By far the most invasive of procedures to treat facial pain, these stimulators are not indicated for the average facial pain patient. Both MCS and DBS are reserved for patients with refractory atypical or deafferentation pain for whom there is no other acceptable form of treatment