Neurostimulation for pain management Flashcards
1
Q
Spinal Cord Stimulation
A
Type
- implantation of electrodes in epidural space
- level of posterior columns in spinal cord
Complexity and Burden
- Invasive
- outpatient surgical procedure
- mid level burden
Mechanism
- modulation of pain signals at spinal cord level
2
Q
Transcutaneous Electrical Stimulation (TENS)
A
Type
- electrodes placed on painful region of skin
Complexity/burden
- non invasive
- low burden
MOA
- mayeb for mixed pain syndromes
- Gate theory
- vibration closes gate for pain information at spinal cord level
- supraspinal mechanism
Complications
- patient response variable
- skin irritation
- avoid with pacemakers,
- avoid near carotid sinusm epiglottis
3
Q
Peripheral Nerve Stimulation (PNS)
A
Type
- implantation of electrodes in subcutaneous tissue over peripheral nerve that innervates affected area
Complexity
- invasive
- outpatient procedure
- intermediate burden
MOA
- Used for occiptal neuralgia, headache, regional pain in abdomen, back, pelvis, cervical areas
- impulse interruption by collision
- gate control within spinal cord
- inhibition of neuroma activity
4
Q
Transcranial direct current stimulation
A
Type
- placement of electrodes on scalp and forehead
- creates electrical field between 2 electrodes
Complexity
- non invasive, minimal burden
MOA
- subthreshold modulation of neuronal resting membrane potential
- change in NMDA receptor
5
Q
Transcranial magnetic stimulation
A
Type
- magnet placed on scalp to stimulate brain tissue
Burden
- non invasive
- painful
- low burden
MOA
- modulation of brain neuronal excitability
6
Q
Deep brain stimulation
A
Type
- leads placed in deep brain structuers
Complexity
- Invasive
- inpatient
- high burden
MOA
- modulates hypothalamus
- thalamus
- periaqueductal gray
7
Q
Motor Cortex Stimulation
A
Type
- Grid placed on motor cortex
Complexity
- Invasive inpatient procedure
- high burden
MOA
- modulates activity of underlying cortex and connections to other brain areas. WTF?
8
Q
Gate theory
A
non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from traveling to the central nervous system.
