Dr Shankar Ramaswamy
Pain medicine

What is neuromodulation therapy and how does it work?

Written by: Dr Shankar Ramaswamy

Published: 16/12/2020

Edited by: Cameron Gibson-Watt

Neuromodulation therapy can be life-changing. It has the power to treat a wide variety of conditions and diseases, ranging from headaches, spinal damage to urinary incontinence - and the list is growing.

Dr Shankar Ramaswamy, a top consultant in anaesthesia, pain management and neuromodulation, explains how it works, which conditions it can treat and the various therapies available.

What is neuromodulation therapy?

Neuromodulation therapy alters the pain signals as they travel to the brain. Through the use of technology, it applies electrical or pharmaceutical stimulation directly to the nerves.

The therapy can be used to treat a variety of different conditions - with chronic pain being the more prominent one.

Other conditions include:

Urinary or bowel incontinence
Complex regional pain syndrome
Neurological conditions such as Parkinson's
Angina
Tremors
Epilepsy
Pelvic floor disorders
Spasticity
Spinal injury
Visual or auditory problems
Specific psychiatric disorders

Neuromodulation therapy can be applied to different areas of the body. For example, if you are suffering from back pain or urinary incontinence, it could be applied to the spine. Similarly, if you suffer from Parkinson’s, it would be applied to the brain.

How does neuromodulation therapy work?

Neuromodulation therapy works through the use of electricity or pharmaceutical (chemical) agents.

Electricity

This involves the use of a device connected to a power source that delivers a low voltage electrical current in a very focused way. It acts by actively stimulating the nerves and producing a special therapeutic response.

Traditional electrical stimulation involved the use of a buzzing or paresthesia sensation, which acted by masking the pain sensation. However, more recently there have been considerable advances in technology, which allows the stimulation to now be delivered without the associated buzzing feeling, also called paresthesia-free stimulation. Examples of such stimulation include high frequency (HF10), burst and sub-threshold stimulation. These advances in technologies have been successful in carefully selected patients to achieve a ‘cure’ in chronic pain, which was previously considered unthinkable.

Another novel neuromodulation therapy has looked at stimulating the multifidus muscle and strengthening the core muscles in patients with refractory mechanical low back pain.

Chemical

These drugs are delivered through special pump devices and work on specific areas of the nervous system.

Who is best suited for this treatment?

Neuromodulation therapy is best suited for patients with chronic pain, as well as those with spinal cord injuries, epilepsy, Parkinson’s and cardiovascular diseases.

Examples of the type of chronic pain may include:

Failed back or neck surgery syndrome
Post-amputation pain
Post-operative pain
Hernia pain
Pain following a total knee replacement
Complex regional pain syndrome
Peripheral neuropathic pain
Cancer pain - refractory cancer pain can be treated with intrathecal morphine pump devices

What are the different neuromodulation therapies available?

As mentioned previously, neuromodulation therapies use either electrical stimulation or targeted drug delivery. Some of the therapies that use electrical stimulation include:

Spinal cord stimulation
Dorsal root ganglion stimulation
Peripheral nerve stimulation- these are available as implantable devices as well as disposable percutaneous devices for one-off or repeated applications
Deep brain stimulation
Vagus nerve stimulation
Sacral nerve stimulation
Gastric and colonic stimulation
Transcranial magnetic stimulation

Therapies that use targeted drug delivery:

Baclofen infusion
Intrathecal drug delivery
Intraventricular drug delivery

Is neuromodulation to treat pain still going ahead during the pandemic?

Yes, neuromodulation therapy is still going ahead during the pandemic. The therapy is being done in highly secure theatres in which there are strict protocols, making the areas COVID-free. This involves screening and throat swabs and the patient is expected to self-isolate in the days before coming into the hospital.

As this treatment doesn’t involve immuno-depressive medication, it is considered a very safe treatment to undergo during the coronavirus pandemic and will not increase your risk of COVID-19 complications.

If you are interested in this treatment and would like to speak to a specialist, visit Dr Shankar Ramaswamy’s Top Doctors profile to book an appointment with him.

By Dr Shankar Ramaswamy

Pain medicine in London

By Dr Shankar Ramaswamy
Pain medicine

An important note with regard to the COVID-19 pandemic: We are offering video consultations to all patients at flexible times and at short notice. This is authorised by all insurance providers. Our team also offers physiotherapy via video consultation and we are able to offer interventions quickly for 'low risk' patients at safe premises in London. We will risk-assess all patients prior to this.

Dr Shankar Ramaswamy is a leading consultant in anaesthesia, pain management and neuromodulation based in Central London, Southeast London and Kent. Among the wide range of conditions that he manages are neck and back pain, headache and facial pain, cancer pain, neuropathic pain, musculoskeletal pain including fibromyalgia and joint pain, abdominal and pelvic pain, sports injury and trauma and accident-related pain including whiplash injury.

He is the clinical lead for the busy inpatient pain service at the Royal London Hospital and also the lead for pain management for the Newham MSK Collaboration. He is also the lead for education in pain management for Barts Health and QMUL and a course director and honorary senior lecturer for MSc Pain Management, University of Edinburgh.

His first qualifications and training in the field of anaesthesia were earned in India, including at one of the most prestigious medical and research institutions in India, the PGIMER. Once in the UK, he continued his anaesthetic training and then underwent the Advanced Pain Fellowship at the renowned Imperial Healthcare, London.

Over the duration of his career, he has garnered extensive experience that he uses to provide care of the highest quality to his patients. He commits to providing comprehensive pain management plans that are centred on each patient's individual needs. He uses a variety of techniques including self-management advice, pharmacotherapy, and cutting-edge (X-ray-guided and ultrasound-guided) interventions such as epidural, facet joint injections, peripheral joint injections (e.g. hips, knees, shoulder), radiofrequency, laser disc therapy, regenerative medicine (PRP) and neuromodulation. He is part of a large multi-disciplinary team to facilitate and individualise pain management approach.

Dr Ramaswamy has also received training in medico-legal report writing and is familiar with civil procedure protocols including CPR part 35 and PD 35 protocol. He can provide detailed insights into causality, prognosis, assessing capacity to work understanding specific roles, assess the ability to function and also comment on the prospect of achieving pain relief. He also offers medicolegal appointments at short notice and can produce a report with a quick turn around time. He sees patients for personal injury claims and criminal negligence claims.