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Spine & Nerve podcast

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We are physicians who practice pain management and physical medicine and rehabilitation, and believe that the main goal of our practice is to improve the quality of life of our patients and communities.We will dive deep into the world of modern pain management to help healthcare providers and consum… read more


Neuromodulation: Riding the WAVE of technology to provide stimulating relief

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves dive a little deeper into the world of neuromodulation therapy with a focus on wave forms and the various wave forms available.

Neuromodulation is a powerful and exciting treatment option for difficult to treat chronic pain conditions.  Some common conditions that neuromodulation is commonly utilized to treat include post laminectomy syndrome (or failed back surgery syndrome) and complex regional pain syndrome; but there are many other applications of this therapy.  
Advances in neuromodulation technology give the ability to individualize a patient's therapy depending of the specific patient and the specific disease process we are treating.  One of the largest advancements has been the progression of the internal pulse generators to provide different wave forms.  A waveform has different components that can be modulated to have the desired therapeutic effect for patients, these different components include the amplitude, the frequency, and the pulse width.  Different wave forms available currently include the following:
1. Traditional spinal cord stimulation (tonic stimulation):
-low frequency (20-120 Hz)
-patients tend to feel the individual pulses
2. High frequency stimulation:
-high frequency (500-10,000 Hz)
-paresthesia free
-benefits include but are not limited to potential improved ability to target traditionally difficult to address areas of pain including low back pain
3. Burst stimulation:
-groups of high frequency pulsed stimulatory phases separated by pulse free phases, followed by a passive recharge phase
-based upon available research, this wave form is most similar to the natural occurring neuronal firing in our central nervous system, which potentially would lower risk of decreasing response to the treatment over time
-less energy demand
Ultimately, neuromodulation is a powerful treatment option (that has evolved significantly over the recent years and continues to advance); that is an effective treatment option for difficult to treat chronic refractory pain conditions.

Disclosure!!! Dr. Brian Joves is a speaker and researcher for companies that produce devices in this space; please see his LinkedIn profile for full details.

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This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

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