Hunter Medical Research Institute
For decades, physicians were drawn to the notion that the power of electrical impulses in the human body could be harnessed for therapeutic aid. After coming to the realization that it was possible to store and control electricity in the mid-18th century, it became a prevalent method in medical applications such as pain relief during dental operations. The understanding that damage to the nervous system could result in chronic pain led to the transition of surgical treatments to reversible and regulated treatments, neuromodulation.
The International Neuromodulation Society defines therapeutic neuromodulation as “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.” This is a technology that acts upon nerves and can be used to re-establish normal function of the nervous system, similar to how cardiac pacemakers re-establish normal heartbeats.
The first deep brain stimulation and spinal cord stimulation were conducted for intractable pain and marked the modern era of neuromodulation. In 1967, C. Norman Shealy created dorsal column stimulators which were spinal cord stimulators, used for pain relief, and the first implantable neuromodulatory device. In 1974, a group of physicians discovered implantanting electrodes outside the subarachnoid space enabled stimulation to occur while reducing side effects. After partaking in computer modeling research for two decades, neurophysiologist, Jan Holsheimer, developed multiple electrode contacts, improving the understanding of how to better position electrodes in the epidural space to maximize therapeutic benefits.
Neuromodulation is most commonly seen in chronic pain relief in cases such as headaches, tremors, or spinal cord damage. However, neuromodulation devices and treatment have a plethora of purposes and can be used in other applications like deep brain stimulation (DBS) treatment for Parkinson’s disease, sacral nerve stimulation for pelvic disorders, and the most common example, spinal cord stimulation (SCS).
SCS is used for chronic pain management and consists of a thin wire placed in the epidural space, a space just outside the spinal cord. Under the skin of the back or buttock, a small generator device is implanted which is attached to the wire. This device delivers low-voltage electrical impulses to the spine, followed by modulation of the pain signals to the brain. Since the introduction to this model, advancements have been made and patients have found better pain control with less feelings of vibrations from the impulses.
The intrathecal pump is another form of neuromodulation, designed to deliver medication into the spinal fluid, allowing drugs to be administered in smaller doses. This is due to there not being a need to metabolize through other body systems before reaching the target area. A catheter is placed in the intrathecal space of the spine and is connected to the pump which holds the medication. The medication can be used for pain alleviation or as a muscle relaxant. This technique can be utilized for certain neurological disorders such as cerebral palsy or multiple sclerosis.
Although neuromodulation treatment is advantageous, it does not come without its risks. Bleeding, infection, blood clots, and reactions to medication are some of the general complications that may occur. Trials have to take place before a device is permanently implanted as everyone’s nervous system may react differently.
Neuromodulation represents a promising and advanced technology with diverse applications in treatment and therapy. However, its long-term use poses risks, including the development of tolerance, addiction, and problematic side effects. Despite these concerns, it holds groundbreaking potential to enhance medical outcomes and improve lives.
Works Cited
Shafik Boyaji, MD, and MD Pritesh Topiwala. “Pain and Neuromodulation: What’s All the ‘Buzz’ About?” Harvard Health, 3 Mar. 2020, www.health.harvard.edu/blog/pain-and-neuromodulation-whats-all-the-buzz-about-2020030318975.
Hu, Charlotte. “Are We Entering a Neurotechnology Renaissance in Healthcare?” Healthcare Brew, Morning Brew, 22 Nov. 2024, www.healthcare-brew.com/stories/2024/11/22/are-we-entering-neurotechnology-renaissance-healthcare.
Sofatzis, Tia. “About Neuromodulation.” International Neuromodulation Society, www.neuromodulation.com/about-neuromodulation.
To, Wing Ting, et al. “Changing Brain Networks through Non-Invasive Neuromodulation.” Frontiers, 19 Mar. 2018, www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2018.00128/full.
“History of Neuromodulation.” International Neuromodulation Society, www.neuromodulation.com/brief-history-neuromodulation#:~:text=The%20modern%20era%20of%20neuromodulation,both%20for%20otherwise%20intractable%20pain.
“Brain Neuromodulation Research Program - HMRI.” Hunter Medical Research Institute, 23 Sept. 2024, hmri.org.au/research/research-program/brain-neuromodulation-research-program/.