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Module 7: SURG0129 - Neuromodulation

SURG0129: Neuromodulation

Student No: 22180482

 

I was really looking forward to starting this module, as it’s the closest thing I've come to medically so far that wouldn’t be amiss in an episode of Star-Trek!

Neuromodulation devices are implanted within the body in the brain or next to nerves or within the epidural space in the spinal cord and are used to stimulate neurons via the delivery of pharmaceutical agents or electrical signals. This aims to modulate the abnormal neural pathway, thus relieving pain or restoring normal activity. Whilst not a panacea for all ills, neuromodulation can be utilised in a variety of ways. The following uses below are ones I personally found the most interesting when reading around the subject:

1. Spinal cord stimulation, where the dorsal aspect of the spinal cord is stimulated for the relief of pain, giving an alternative option where traditional pharmacological therapies have failed or become ineffective.

2. Peripheral nerve stimulation, where the nerve is stimulated to activate or modulate the activity of neurones, which is ideal for treating neuropathic pain which follows a single nerve distribution.

3. Deep brain stimulation – used to relieve pain via electrodes implanted in the brain to restore movement, at least partially, in conditions such as Parkinson’s disease. It can also help conditions such as essential tremor, dystonia, depression and epilepsy.

4. Trigeminal nerve stimulation – to stimulate the nerve to relieve the pain of trigeminal neuralgia.

5. Pudendal nerve stimulation. If the pudendal nerve gets damaged, it may result in continence issues or constant unremitting pain. Stimulation of this nerve via a peripheral nerve stimulator could relieve pain as well as facilitate sphincter muscle contraction, thereby assisting or preserving continence.

Frustratingly, it's not too widely known about, and its study is almost a niche in medical circles. When I asked a very small sample of my local GP’s, neither of them professed to know anything in-depth about it or its potential.

I think too, that despite its huge potential, neuromodulation receives very little in the way of funding. Without funding, how are we supposed to be able to spread the word, utilise it more, and then collect more data to encourage further research and development? With so many different applications of neuromodulation, it can potentially be life-altering for many patients across various medical specialities.
I expect that gradually, over time, the techniques offered will become more well-known, with more patients extolling the virtues of their devices and how they have enhanced their quality of life and reduced their pain.

It is incredibly important that ample patient education takes place before considering a neuromodulation device, and that patient expectations are well managed. It won't offer a ‘magic fix’ for everything, but it could undoubtedly change many patients' lives for the better.

In my clinical life, I don’t think this module will really change my way of practice. In 27 years of osteopathy, I’ve only recently met a patient who presented with a subcutaneous stimulation device in situ, which was there to help manage her bowel incontinence by acting on the nerves supplying the anal sphincter musculature. She had one of the older devices that would require surgery (and all the risks therein) to change to the battery pack. I hope when she next has this done, she can get a newer model which will allow for remote battery recharging. Practically, as my job is a hands-on therapy, I was concerned that somehow I might be able to somehow accidentally displace her electrodes by moving her as I treated her spine, but I am reassured now that this is highly unlikely, having read and watched videos on how the devices are placed and tethered. Nevertheless, I will remain cautious if I encounter a patient with a similar device again!
I need to see what the referral pathway is in my area, as I have some chronic pain patients who could possibly be helped via neuromodulation devices.

A limitation of my profession is that I never get to see surgery, only the after-effects. I therefore hadn’t fully considered those prospective neuromodulation patients who have coagulation disorders or the infection risks associated with the placement of the devices. I thought the course material covered this very well, and I found it very interesting. One of the reasons for doing these studies was to see beyond my own professional bubble, and this module has certainly delivered on that.

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